Active treatment for extremely preterm infants on the rise, racial disparities remain

The frequency of active treatment in newborns born between 22 and 25 weeks’ gestation increased over 7 years in the United States, according to a serial cross-sectional analysis published in JAMA.

Further, those born to Asian/Pacific Islander, Black and Hispanic/Latina mothers had a decreased likelihood of receiving active treatment, according to the study.

“From 2014 to 2020 in the U.S., the frequency of active treatment among neonates born alive between 22 weeks, 0 days and 25 weeks, 6 days significantly increased, and there were differences in rates of active treatment by race and ethnicity,” Kartik K. Venkatesh, MD, PhD, a high-risk obstetrician and perinatal epidemiologist at The Ohio State University Wexner Medical Center, and colleagues wrote.

Identifying, defining active treatment

Venkatesh and colleagues examined natality data from the National Center for Health Statistics from 2014 to 2020 to observe active treatment patterns in live-born neonates delivered between 22 weeks, 0 days and 25 weeks, 6 days.

Researchers defined active treatment as “a composite of surfactant therapy, immediate assisted ventilation at birth, assisted ventilation more than 6 hours in duration and/or antibiotic therapy.”

They also examined whether treatment varied by gestational age at birth or by race and ethnicity.

Trends in active treatment

In total, 61,908 singleton, live-born neonates without clinical anomalies were included. Maternal race and ethnicity of those included was 5% Asian/Pacific Islander, 37% Black, 24% Hispanic/Latina and 34% white. Also, 14% of newborns were born at 22 weeks, 21% at 23 weeks, 30% at 24 weeks and 34% at 25 weeks.

Active treatment was provided to 52% of the newborns in the study population. From 2014 to 2020, researchers found that active treatment frequency increased significantly from 45.7% to 58.8% (mean annual percent change [APC], 3.9%; 95% CI, 3%-4.9%).

The frequency of active treatment increased with gestational age at birth, and the mean APC from 2014 to 2020 increased most quickly at younger gestational ages at birth. For instance, active treatment frequency increased from 14% to 28.7% for newborns born at 22 weeks’ gestation (mean APC, 14.4%; 95% CI, 11.1%-17.7%) and from 53.1% to 65.1% for those born at 25 weeks’ gestation (mean APC, 2.9%;95% CI, 1.5%-4.2%).

Racial, ethnic differences

Additionally, a rise in overall active treatment frequency was observed for all racial and ethnic subgroups, with Black and Hispanic/Latina women having the highest mean APC (both, 4.7%; 95% CI, 3.4%-5.9%).

However, compared with the 57% of newborns born to white women who received active treatment, researchers observed that newborns of Asian/Pacific Islander (46.2%; adjusted RR [aRR] = 0.82; 95% CI, 0.79-0.86), Black (51.6%; aRR = 0.9; 95% CI, 0.89-0.92) and Hispanic/Latina (48%; aRR = 0.83; 95% CI, 0.81-0.85) women were significantly less likely to be given active treatment in the periviable period.

Venkatesh and colleagues wrote that treatment may differ by race and ethnicity due to several factors, including structural racism, social determinants of health and implicit bias.

“These factors may affect parental preferences which consequently influence neonatal treatment decisions,” Venkatesh and colleagues wrote. “Clinician counseling and intervention in the periviable period may also differ by the race and ethnicity of the patient.”