Association of Racial Disparities With In-Hospital Outcomes in Severe Bronchopulmonary Dysplasia

Abstract

ronchopulmonary dysplasia (BPD) is the most common morbidity of preterm birth affecting 50% of infants born less than 30 weeks' gestation in the US. 1 Despite preventive efforts, the incidence of BPD is increasing owing to the improved survival of infants born extremely preterm. 2 Recent studies suggest racial disparities may adversely affect outcomes for preterm infants experiencing common neonatal morbidities, including respiratory distress syndrome, intraventricular hemorrhage, and necrotizing enterocolitis, during the initial neonatal intensive care unit (NICU) hospitalization. [3][4][5] However, our knowledge of the association of racial disparities with outcomes for preterm infants with BPD remains unclear.Multiple prospective cohort studies have determined that Black maternal race is independently associated with a de-creased risk of severe BPD at 36 weeks' postmenstrual age (PMA), when the diagnosis of BPD is made. 6,7 Additional analyses of these cohorts, however, also identify Black maternal race as an independent risk factor for increased respiratory morbidity in early childhood. 6,8,9 The mechanisms underlying the finding that preterm infants born to Black mothers are at decreased risk of developing severe BPD but are nonetheless at increased risk of early childhood respiratory morbidity remain unknown.The 2001 National Institutes of Health (NIH) consensus criteria define severe BPD in infants born less than 32 weeks' gestation as the need for supplemental oxygen for 28 days or more and a fraction of inspired oxygen greater than 0.3 and/or positive pressure at 36 weeks' PMA. 10 Short-and long-term outcomes for patients with BPD are highly variable. In this study, IMPORTANCE Bronchopulmonary dysplasia (BPD) is the most common serious morbidity of preterm birth. Short-term respiratory outcomes for infants with the most severe forms of BPD are highly variable. The mechanisms that explain this variability remain unknown and may be mediated by racial disparities.OBJECTIVE To determine the association of maternal race with death and length of hospital stay in a multicenter cohort of infants with severe BPD.

Outcomes of infants with severe bronchopulmonary dysplasia who received tracheostomy and home ventilation

“…Ryan et al 27 observed in the large Prematurity and Respiratory Outcomes Program (PROP) cohort that Black infants had a lower risk of BPD despite lower gestational age, lower antenatal steroid exposure and higher rate of intubation at birth. On the other hand, Lewis et al 28 in a multicenter cohort of infants with severe BPD, found that Black infants had increased likelihood of death and increased length of hospital stay compared to White infants after adjusting for illness severity. Keller et al 29 also observed higher and severe post prematurity disease morbidity in Black infants with BPD in comparison to White and non‐Hispanic infants.…”

Sociodemographic factors associated with tracheostomy and mortality in bronchopulmonary dysplasia

“…Findings have ranged from reports of a lower incidence among children of Black women, 6 to no association with race/ethnicity, 7 to a recent investigation demonstrating in a “fetuses‐at‐risk” analysis that Black mothers have a greater than four times increased risk of their infant being diagnosed with BPD 5 . Studies evaluating outcomes within the BPD population are more uniform 8,9 . Black infants demonstrate an increased risk of hospital admission, longer lengths of hospital stay, and increased odds of mortality 8,9 .…”

“…5 Studies evaluating outcomes within the BPD population are more uniform. 8,9 Black infants demonstrate an increased risk of hospital admission, longer lengths of hospital stay, and increased odds of mortality. 8,9 Socioeconomic status as measured by neighborhood median household income 10,11 and neighborhood deprivation index 12 has also been associated with higher rates of readmission and mortality in patients with BPD.…”

Is There a Real Association of Racial Disparities With In-Hospital Outcomes in Severe Bronchopulmonary Dysplasia?

“…Additionally, Black infants have been shown to have a significant decrease in the composite outcome of death or BPD with inhaled nitric oxide . In the study by Lewis et al, instead of more exposure, Black infants had less exposure to inhaled nitric oxide than White infants (2% vs 4%, respectively). Could less than optimal use of systemic steroids and inhaled nitric oxide in Black infants have contributed to the increased mortality observed?…”

“…To the Editor We read with interest the study by Lewis et al suggesting that infants with severe bronchopulmonary dysplasia (BPD) born to Black mothers had increased odds of death and increased length of hospital stay compared with infants born to White mothers. We agree with the authors that we need to prevent structural inequities in neonatal intensive care units.…”