Babies born extremely preterm were more prone to receive active treatment recently, but there have been gaps in treatment among different racial and ethnic groups, in accordance with a cross-sectional study.
From 2014 to 2020, the proportion of extremely preterm infants who received active treatment rose nearly 4% every year (45.7% to 58.8%), increasing in every racial and ethnic groups, reported Kartik K. Venkatesh, MD, PhD, of the Ohio State University College of Medicine in Columbus, and colleagues.
The frequency of active treatment increased in every gestational age ranges, & most rapidly among babies born in week 22 of pregnancy, at the average increase of 14.4% each year in the analysis time frame (from 14.0% to 29.7%), they stated in JAMA.
However, babies born to white individuals were more prone to undergo treatment in comparison to those born to Asian or Pacific Islander, Black, or Hispanic people. The authors stated that in “2019, 66% of periviable neonates were born to a mother who defined as either non-Hispanic Black or Hispanic,” and said “one possible explanation for variations in active treatment in the periviable period by race and ethnicity could be differing decisions of clinicians and families when confronted with the high probability of morbidity and mortality and predictive uncertainty.”
Within an accompanying editorial, Henry Lee, MD, and Deirdre Lyell, MD, both of the Stanford University School of Medicine in California, noted that more data are essential about treatment efficacy and prognosis. They added too little data describing an infant’s individual morbidity and mortality risk after active treatment creates barriers to effective counseling, because the definition of active treatment is unclear and influenced by the region in which a patient receives care, the amount of care at a hospital, and the average person family.
“Unlike other interventions which may be considered appropriate or optimal for an easy population, it really is challenging to characterize active treatment and its own components for the extremely premature population as always the ‘right’ treatment, given the uncertainties in the probability of survival and survival without morbidity,” they stated. “Quality care in this context ought to be viewed much less a straightforward matter of pursuing active treatment but instead because the optimal alignment of treatment, prognosis, and the values of mom and family.”
The serial cross-sectional study, obtaining data on live births between 2014 and 2020 with data from the U.S. National Vital Statistics System Natality Files. Venkatesh’s group collected data from all live births, defining periviable births as infants born between 22 weeks’ and 25 weeks and 6 days’ gestation. The researchers excluded infants who have been not U.S. residents and the ones with clinical anomalies.
They analyzed the proportion of neonates who received active treatment, including interventions such as for example surfactant therapy, immediate assisted ventilation at birth, assisted ventilation for a lot more than 6 hours, and antibiotic therapy during neonatal ICU admission. They adjusted for covariates including maternal education, insurance status, year of delivery, age, parity, prepregnancy BMI, preterm birth, gestational diabetes, infant birthweight and sex, amongst others.
Of nearly 27 million live births in the U.S., approximately 62,000 extremely preterm neonates were contained in the final analysis. The median maternal age was 28 and 54% of births were included in Medicaid.
Around 5% of the infants in the analysis were Asian or Pacific Islander, 37% were Black, 24% were Hispanic, and 34% were white.
Of most periviable births, just over half received active treatment. Approximately 45% who received active treatment underwent surfactant therapy, 96% immediate assisted ventilation at birth, 60% assisted ventilation for a lot more than 6 hours, and 47% antibiotic therapy.
In comparison to infants born to white individuals, those born to Asian or Pacific Islander (adjusted risk ratio [aRR] 0.82, 95% CI 0.79-0.86), Black (aRR 0.90, 95% CI 0.89-0.92), or Hispanic (aRR 0.83, 95% CI 0.81-0.85) individuals were less inclined to receive active treatment. Infants born to folks of color who have been also delivered at 23, 24, and 25 weeks’ gestation were all considerably less more likely to receive active treatment.
Study limitations included having less assessment of neonatal morbidity and mortality. Also, the researchers didn’t include stillbirths in the analysis, which raises the chance for selection bias concerning the coding of deliveries as live births or stillbirths. And previous studies experienced varying definitions of active treatment, the authors described.
The analysis was funded by the Care Innovation and Community Improvement Program at the Ohio State University and the National Heart, Lung, and Blood Institute.
Venkatesh disclosed no relationships with industry. Co-authors disclosed support from, and/or relationships with, the NIH, Baxter International, Siemens Healthcare, Progenity, and the American Heart Association.
Lee and Lyell disclosed support from, and/or relationships with the NIH, the Society for Maternal-Fetal Medicine, the University of California SAN FRANCISCO BAY AREA, Bloomlife, and Zenflow.