Systemic and Structural Racism Present in U.S. Neonatal Intensive-care Units

By Reuters Staff

July 23, 2021

NEW YORK (Reuters Health) - Quality of care across and within neonatal intensive-care units (NICUs) in the United States varies by race and ethnicity, according to a new study that points to systemic and structural racism starting at birth.

This study highlights "many important quality gaps that raise unanswered questions about the relationships between race and ethnicity and processes and outcomes of care," the study team says in their Pediatrics paper.

"Ultimately, until neonatal and pediatric clinicians and providers accept that they must practice social as well as technical medicine and follow through to address social determinants of health and act against racism, we will not achieve comparable high-quality care for all infants," they add.

For their study, Dr. Erika Edwards of the Vermont Oxford Network and the University of Vermont, in Burlington, and colleagues used Baby-MONITOR, a summary quality measure for NICUs.

This tool includes nine elements including five process measures (any human milk at discharge, no admission hypothermia, antenatal steroid exposure, no healthcare-associated infection, and timely retinal examination) and four outcome measures (survival to hospital discharge, no chronic lung disease, no pneumothorax, and greater than median growth velocity).

A higher Baby-MONITOR score indicates a higher quality of care.

The prospective cohort study included 169,400 infants born between 25 to 29 weeks' gestation or with a birth weight of 401 to 1,500 grams at 737 U.S. hospitals.

When compared with non-Hispanic white infants, African American and American Indian infants had significantly lower (worse) process scores on discharge on human milk, no admission hypothermia, and antenatal steroid exposure. And African American, Hispanic, Asian American and American Indian infants had higher (better) outcome scores on survival to hospital discharge, no chronic lung disease, and no pneumothorax, the authors report.

"An increased risk for preterm birth, receipt of lower quality care, and socioeconomic disadvantages over of the life course are all markers of the structural and systemic racism found in the United States," they point out.

"Even within the same hospitals, African American infants received lower average scores on important markers of quality of care, such as the receipt of antenatal steroids and having no hypothermia on admission. We also found that the geographical location of hospitals continues to play a role in determining the quality of care by race and ethnicity," they note.

To their knowledge, this is the first study to use Baby-MONITOR to evaluate the quality of care for American Indians and these infants had lower average process score and higher average outcome score, compared with that of white infants.

"American Indian mothers have the second highest rates of preterm birth behind non-Hispanic African American mothers. Addressing the quality of care that Native Americans receive deserves further attention with consideration of the context of the specific perinatal risk factors that American Indian women face," Dr. Edwards and colleagues suggest in their paper.

SOURCE: Pediatrics, online July 22, 2021.