A review of published studies found numerous disparities in the care of minority infants in neonatal intensive care units (NICUs).
Knowing that preterm birth or very low birth weight is the leading cause of death for black infants, researchers set out to look at the care these infants received at the start of their lives.
Authors analyzed 40 articles, most of which found disparities, according to “Racial/Ethnic Disparities in Neonatal Intensive Care: A Systematic Review,” (Sigurdson K, et al. Pediatrics. July 28, 2019, https://pediatrics.aappublications.org/content/early/2019/07/25/peds.2018-3114).
The disparities they found included:
- Neonatal mortality rates were higher in hospitals in which most very low birth weight infants were black.
- Black and Hispanic infants received breast milk at lower rates than white infants. Black mothers reported limited breastfeeding support.
- Minority breast milk feeding rates improved in hospitals with more white mothers.
- Hospitals with large numbers of black patients experienced more nurse understaffing than hospitals with low numbers of black patients.
- Referrals for early intervention were lower for black and Hispanic infants with very low birth weight than white infants.
- Black infants had a two-fold greater risk of dying from intraventricular hemorrhage than white infants.
- Survival rates for infants with necrotizing enterocolitis were lower for Hispanic infants than non-Hispanic infants.
Authors noted two themes.
"First, infants of color, especially black and Hispanic infants, are more likely to receive care in quality-challenged hospitals," they wrote. "Second, disparities also exist within NICUs."
Some of these disparities could be fixed by improving hospital processes.
“Researchers are now looking at chronic stress caused by societal, institutional or interpersonal racism as causal factors for preterm birth and this review suggests that these factors are also causal factors for racial/ethnic disparities in NICU quality of care,” according to the study. “Targeted quality improvement efforts hold promise for improving racial/ethnic equity in care delivery.”
In a related commentary, experts from the Centers for Disease Control and Prevention’s Division of Reproductive Health recommend requiring all hospitals to participate in quality improvement initiatives, implementing best practices, ensuring infants are cared for in facilities that can best address their needs and expanding research into the causes of disparities in health care.
"Quality improvement for adult patient care has revealed, when implemented with a specific eye on 'closing the gap,' that disparities can be reduced," they wrote. "We owe the infants of this country consistent high-quality care, no matter their skin color, and this article documents that there is work to be done."
