Extremely premature infants: How does death in the delivery room influence mortality rates in two level 3 centers in France?

Forner, O.; Schiby, A.; Ridley, Ashley; Thiriez, Gérard; Mugabo, I.; Morel, Vanessa; Mulin, B.; Filiatre, J.-C.; Riethmuller, Didier; Levy, Gil; Semama, Denis S.; Martin, Donald A.; Chantegret, C.; Bert, S.; Godoy, Florence; Sagot, P; Rousseau, Thierry; Burguet, A.

doi:10.1016/j.arcped.2018.06.006

Cited by 2 publications

(1 citation statement)

References 27 publications

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“…Similarly, delivery room deaths and deaths in the first 12 h have been excluded to avoid potential institutional differences in perinatal care affecting an infant’s status at birth, approaches to resuscitation, and decisions for comfort care. 6 Congenital anomalies are often excluded to avoid the complexity of their risk adjustment, in the hopes of creating a more level playing field for comparison. In addition, because the VLBW designation has had long and familiar use, some investigators prefer selecting their study cohorts based on birth weight rather than gestational age.…”

Section: Introductionmentioning

confidence: 99%

Cohort selection and the estimation of racial disparity in mortality of extremely preterm neonates

et al. 2023

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Background Racial disparities in preterm neonatal mortality are long-standing. We aimed to assess how cohort selection influences mortality rates and racial disparity estimates. Methods With 2014–2018 California data, we compared neonatal mortality rates among Black and non-Hispanic White very low birth weight (VLBW, <1500 g) or very preterm infants (22–29 weeks gestational age). Relative risks were estimated by different cohort selection criteria. Blinder-Oaxaca decomposition quantified factors contributing to mortality differential. Results Depending upon standard selection criteria, mortality ranged from 6.2% (VLBW infants excluding first 12-h deaths) to 16.0% (22–29 weeks’ gestation including all deaths). Black observed neonatal mortality was higher than White infants only for delivery room deaths in VLBW infants (5.6 vs 4.2%). With risk adjustment accounting for higher rate of low gestational age, low Apgar score and other factors, White infant mortality increased from 15.9 to 16.6%, while Black infant mortality decreased from 16.7 to 13.7% in the 22–29 weeks cohort. Across varying cohort selection, risk adjusted survival advantage among Black infants ranged from 0.70 (CL 0.61–0.80) to 0.84 (CL 0.76–0.93). Conclusions Standard cohort selection can give markedly different mortality estimates. It is necessary to reduce prematurity rates and perinatal morbidity to improve outcomes for Black infants. Impact In this population-based observational cohort study that encompassed very low birth weight infant hospitalizations in California, varying standard methods of cohort selection resulted in neonatal mortality ranges from 6.2 to 16.0%. Across all cohorts, the only significant observed Black-White disparity was for delivery room deaths in Very Low Birth Weight births (5.6 vs 4.2%). Across all cohorts, we found a 16–30% survival advantage for Black infants. Cohort selection can result in an almost three-fold difference in estimated mortality but did not have a meaningful impact on observed or adjusted differences in neonatal mortality outcomes by race and ethnicity.

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Section: Introductionmentioning

confidence: 99%

Cohort selection and the estimation of racial disparity in mortality of extremely preterm neonates

et al. 2023

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Methodologic considerations in estimating racial disparity of mortality among very preterm infants

Jiang,

Rose,

Gould

et al. 2024

Pediatr Res

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This review explores methodological considerations in estimating racial disparities in mortality among very preterm infants (VPIs). Significant methodological variations are evident across studies, potentially affecting the estimated mortality rates of VPIs across racial groups and influencing the perceived direction and magnitude of racial disparities. Key methodological approaches include the birth-based approach versus the fetuses-at-risk approach, with each offering distinct insights depending on the specific research questions posed. Cohort selection and the decision for crude versus adjusted comparison are also critical elements that shape the outcomes and interpretations of these studies. This review underscores the importance of careful methodological planning and highlights that no single approach is definitively superior; rather, each has its strengths and limitations depending on the research objectives. The findings suggest that adjusting the methodological approach to align with specific research questions and contexts is essential for accurately assessing and addressing racial disparities in neonatal mortality. Impact Elucidates the impact of methodological choices on perceived racial disparities in neonatal mortality. Offers a comprehensive comparison of birth-based vs. fetuses-at-risk approaches in the context of racial disparity research. Provides guidance on the cohort selection and adjustment criteria critical for interpreting studies on racial disparities in very preterm infant mortality.

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Extremely premature infants: How does death in the delivery room influence mortality rates in two level 3 centers in France?

Cited by 2 publications

References 27 publications

Cohort selection and the estimation of racial disparity in mortality of extremely preterm neonates

Cohort selection and the estimation of racial disparity in mortality of extremely preterm neonates

Methodologic considerations in estimating racial disparity of mortality among very preterm infants

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