Editor’s Note: Dr. Eli Cahan (he/him) is the editor emeritus of the Section on Pediatric Trainees (SOPT) feature in Pediatrics, and an investigative journalist who covers child welfare. He is also a resident at The Boston Combined Residency Program. -Rachel Y. Moon, MD, Associate Editor, Digital Media, Pediatrics
“Are you sure?”
Alexandra looked at me, wide eyed. Her son, Jeremy, lay quietly in her arms. (Names are changed to preserve anonymity.)
“We think he’s safe for discharge,” I repeated. “We know how hard you’ve been working,” I added, “and how ready you are to care for him at home.”
Alexandra was less certain. It had been a long 3 months in the NICU. She knew she could do it—but that didn’t make it less scary. And, stable though Jeremy may be, it didn’t make him less fragile. He was still an ex-premie, he still had bronchopulmonary dysplasia, and he still had oral feeding intolerance.
In that moment, Alexandra found herself in a similar position to tens of thousands of US parents. According to 2022 data collected by March of Dimes, over 350,000 US babies are born preterm every year. Of these, over 50,000 are born—like Jeremy—very preterm.
Historically, for babies like Jeremy, discharge from the NICU with multiple medical problems was common. Once upon a time, discharging an infant born very preterm from the NICU with home oxygen and a gastric tube might have been considered one of the best possible outcomes.
But, increasingly, these infants are leaving the NICU without any accessories at all. Indeed, an article and accompanying video abstract by Jessica Liu, PhD, and colleagues at Stanford University and University of California San Diego, which is being early released this month in Pediatrics, found that, in 2021, nearly two-thirds of all California babies born very preterm survived without any major comorbidities (10.1542/peds.2024-066439). This represents a 6% improvement in morbidity-free survival in the past decade—an immense success by any standard.
However, these gains were not evenly distributed. Morbidity-free survival was significantly lower in Hispanic infants compared with infants from any other ethnic group across hospital settings.
Moreover, infants who were non-Hispanic Black or Hispanic were more likely to receive care in safety net NICUs, which in turn was associated with lower rates of morbidity-free survival: 64.2% versus 69.6% in non-safety net NICUs. As such, while Black infants had morbidity-free survival rates approximating those of non-Hispanic Whites and Asians across hospital settings, their morbidity-free survival dropped nearly 10% if they were in safety net NICUs.
More research is needed to uncover the root causes of these disparities, the authors say, including those related to sociodemographic factors that may increase the vulnerability of maternal-infant dyads.
“We recognize that race as a variable in medical research is debated, and that race and ethnicity are social constructs,” the authors wrote, “however, in the context of this study, examining outcomes by race and ethnicity allows us to recognize continued health inequities and systemic racism . . . and identify underserved populations in need of targeted quality improvement.”
“Not doing so,” they added, “would risk concealing health disparities and ignoring the realities of social stratification and injustice.”
This article represents an important contribution to the literature about health inequities in NICU populations and offers insight into health inequities in children with medical complexity across ages.
