Disparities in Infant Mortality and Effective, Equitable Care: Are Infants Suffering from Benign Neglect?

Rowley, D.; Hogan, Vijaya K.

doi:10.1146/annurev-publhealth-031811-124542

Cited by 25 publications

(17 citation statements)

References 62 publications

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“…29-34 However, this is the first report of maternal racial/ethnic identity as a predictor of oral feeding progression for preterm infants. This was especially surprising given that infants of Latina versus African-American mothers had higher birthweights (mean = 1844 and 1733, respectively, p = 0.08) and higher five-minute Apgar scores (mean = 8.61 and 7.85, respectively, p < 0.0001), on average.…”

Section: Discussionmentioning

confidence: 85%

Exploring Factors Related to Oral Feeding Progression in Premature Infants

White‐Traut

Pham

Rankin

et al. 2013

Advances in Neonatal Care

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Purpose To identify infant and maternal characteristics associated with the pace of progression from the first oral feeding to complete oral feeding. Subjects One hundred forty-two stable premature infants who were fully or partially gavage feeding immediately after birth (29-34 weeks gestational age at birth). Design Exploratory secondary analysis. Method Data are from an ongoing randomized clinical trial of a developmental maternally-administered intervention (H-HOPE) for mother-infant dyads at high social-environmental risk. Main Outcome Measures Oral feeding progression (transition time from the first attempt to complete oral feeding). Sample Characteristics The convenience sample of preterm infants consisted of 48.6% male infants; the mean gestational age (GA) at birth was 32.4 weeks and mean birthweight was 1787 grams; African American mothers (47.9%, n = 80) and Latina mothers (52.1%, n = 83). Principle Results Multivariable linear regression results showed that, on average, the number of days for infants of Latina mothers to achieve complete oral feeding was 2.43 days longer than for infants of African-American mothers. In addition, lower birthweight and lower postmenstrual age (PMA) at first oral feeding were associated with longer feeding progression. Higher infant morbidity was correlated with longer feeding progression. Conclusion Infants with Latina mothers, lower birthweight, lower PMAs at first oral feeding, and higher morbidity scores had a longer transition from first to complete oral feeding. Identification of infants at risk for delayed transition from first to complete oral feeding may allow for the development and testing of appropriate interventions that support the transition from gavage to complete oral feeding.

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Section: Discussionmentioning

confidence: 85%

Exploring Factors Related to Oral Feeding Progression in Premature Infants

White‐Traut

Pham

Rankin

et al. 2013

Advances in Neonatal Care

View full text Add to dashboard Cite

show abstract

“…There are modest and mixed findings regarding disparities in vaginal birth after caesarean, nonindicated early-term birth, and primary caesarean section (76,85,102); steroids during preterm labor (90,120); and surfactants for preterm infants (71,75). It is not clear if disparities reflect within-or between-provider effects or unmeasured morbidity.…”

Section: Obstetrical Carementioning

confidence: 99%

Racial and Ethnic Disparities in the Quality of Health Care

Fiscella

Sanders

2016

Annu. Rev. Public Health

365

232

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The annual National Healthcare Quality and Disparities Reports document widespread and persistent racial and ethnic disparities. These disparities result from complex interactions between patient factors related to social disadvantage, clinicians, and organizational and health care system factors. Separate and unequal systems of health care between states, between health care systems, and between clinicians constrain the resources that are available to meet the needs of disadvantaged groups, contribute to unequal outcomes, and reinforce implicit bias. Recent data suggest slow progress in many areas but have documented a few notable successes in eliminating these disparities. To eliminate these disparities, continued progress will require a collective national will to ensure health care equity through expanded health insurance coverage, support for primary care, and public accountability based on progress toward defined, time-limited objectives using evidence-based, sufficiently resourced, multilevel quality improvement strategies that engage patients, clinicians, health care organizations, and communities.

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“…Some studies have reported lower prenatal utilization rates in Black people compared to other races, particularly early in pregnancy. This intentional underutilization of prenatal care has been suggested through patient interviews to be due in part to exposure to institutionalized racism and perceived bias when presenting to medical attention [ 8 , 9 , 10 ]. While later presentation to care may negatively impact maternal and infant outcomes, recent trends suggest the gap in prenatal care utilization is rapidly closing between races so access to care does not fully explain the disparities in birth outcomes [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

Racial Differences in the Biochemical Effects of Stress in Pregnancy

Ekeke

Méndez

Yanowitz

et al. 2020

IJERPH

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Prenatal stress has been linked to preterm birth via inflammatory dysregulation. We conducted a cross-sectional study on female participants who delivered live, singleton infants at University of Pittsburgh Medical Center Magee Women’s Hospital. Participants (n = 200) were stratified by cumulative risk scores using a combination of individual factors (maternal education, diabetes, hypertension, smoking, relationship status, obesity, depression) and neighborhood deprivation scores. We hypothesized that inflammatory cytokines levels differ by risk group and race. Multiplex analyses of IL-6, IL-8, IL-10, IL-13 and TNF-alpha were run. We found that Black birthing people had more risk factors for chronic stress and had lower levels of IL-6 compared to White birthing people. When stratified by risk group and race, low-risk Black birthing people had lower levels of IL-6 compared to low-risk White birthing people, and high-risk Black birthing people had lower levels of IL-8 compared to high-risk White birthing people. Higher area deprivation scores were associated with lower IL-6 levels. Our results suggest that the relationship between chronic stress and inflammatory cytokines is modified by race. We theorize that Black birthing people encounter repetitive stress due to racism and social disadvantage which may result in stress pathway desensitization and a blunted cytokine response to future stressors.

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Disparities in Infant Mortality and Effective, Equitable Care: Are Infants Suffering from Benign Neglect?

Cited by 25 publications

References 62 publications

Exploring Factors Related to Oral Feeding Progression in Premature Infants

Exploring Factors Related to Oral Feeding Progression in Premature Infants

Racial and Ethnic Disparities in the Quality of Health Care

Racial Differences in the Biochemical Effects of Stress in Pregnancy

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