Racial and Ethnic Differences in Use of Intubation for Periviable Neonates

Edmonds, Brownsyne Tucker; Fager, Corinne; Srinivas, Sindhu K.; Lorch, Scott

doi:10.1542/peds.2010-2608

Cited by 43 publications

(20 citation statements)

References 37 publications

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“…Factors that have been implicated in interventions at the limits of viability include maternal age, parity, race, insurance status, education, prenatal care, gestational age, and birth weight [11]. These decisions are often made under inherently stressful circumstances for the affected family and the health care providers who must make the classification.…”

Section: Discussionmentioning

confidence: 99%

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Variation in classification of live birth with newborn period death versus fetal death at the local level may impact reported infant mortality rate

et al. 2014

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BackgroundTo better understand factors that may impact infant mortality rates (IMR), we evaluated the consistency across birth hospitals in the classification of a birth event as either a fetal death or an early neonatal (infant) death using natality data from North Carolina for the years 1995–2000.MethodsA database consisting of fetal deaths and infant deaths occurring within the first 24 hours after birth was constructed. Bivariate, followed by multivariable regression, analyses were used to control for relevant maternal and infant factors. Based upon hospital variances, adjustments were made to evaluate the impact of the classification on statewide infant mortality rate.ResultsAfter controlling for multiple maternal and infant factors, birth hospital remained a factor related to the classification of early neonatal versus fetal death. Reporting of early neonatal deaths versus fetal deaths consistent with the lowest or highest hospital strata would have resulted in an adjusted IMR varying from 7.5 to 10.64 compared with the actual rate of 8.95.ConclusionsValid comparisons of IMR among geographic regions within and between countries require consistent classification of perinatal deaths. This study demonstrates that local variation in categorization of death events as fetal death versus neonatal death within the first 24 hours after delivery may impact a state-level IMR in a meaningful magnitude. The potential impact of this issue on IMRs should be examined in other state and national populations.

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Section: Discussionmentioning

confidence: 99%

“…Differences in birth rates of very preterm infants can lead to substantial differences in unadjusted IMRs across demographic groups or regions [5-10]. Approaches to birth classification, resuscitation, and care of the extremely preterm infant may alter outcome and influence the IMR [11]. …”

Section: Introductionmentioning

confidence: 99%

Variation in classification of live birth with newborn period death versus fetal death at the local level may impact reported infant mortality rate

et al. 2014

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“…There is no legal precedent set for this topic , and consequently, physicians' beliefs regarding neonatal delivery room resuscitation practices of periviable infants vary greatly within the United States (USA) . Factors such as uncertainty of precise gestational age determinations, geographical location, residency training, racial differences and even the apparent devaluation of premature infants by society have all been associated with decisions to resuscitate periviable infants .…”

Section: Introductionmentioning

confidence: 99%

Attitudes towards the resuscitation of periviable infants: a national survey of American Muslim physicians

et al. 2015

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“…In previous work, we have observed racial differences in periviable resuscitation decisions 16 but also found that race was not a predictor of periviable cesarean decisions in the same cohort of infants. 36 It is difficult to know whether the observed racial differences in neonatal intubation reflect variations in patient preferences or provider counselling practices, but the fact that resuscitation differed by race, while mode of delivery did not, suggests that the variation may reflect differences in provider practice.…”

Section: Discussionmentioning

confidence: 64%

“…16,17 Little is known about the source of these differences, although extrapolation from the end-of-life decision-making literature suggests that black and Hispanic patients may have fundamentally different treatment preferences. 18–24 An alternative explanation is that ineffective and/or biased patient-provider communication may underlie these differences.…”

Section: Introductionmentioning

confidence: 99%

Using Simulation to Assess the Influence of Race and Insurer on Shared Decision Making in Periviable Counseling

Edmonds¹,

McKenzie

Fadel

et al. 2014

Simulation in Healthcare: The Journal of the Society for Simulation in Healthcare

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Introduction Sociodemographic differences have been observed in the treatment of extremely premature (periviable) neonates, but the source of this variation is not well understood. We assessed the feasibility of using simulation to test the effect of maternal race and insurance status on shared decision-making (SDM) in periviable counseling. Methods We conducted a 2 × 2 factorial simulation experiment in which obstetricians and neonatologists counseled two consecutive standardized patients (SPs) diagnosed with ruptured membranes at 23 weeks, counterbalancing race (black/white) and insurance status using random permutation. We assessed verisimilitude of the simulation in semi-structured debriefing interviews. We coded physician communication related to resuscitation, mode of delivery, and steroid decisions using a 9-point SDM coding framework; then compared communication scores by SP race and insurer using ANOVA. Results Sixteen obstetricians and 15 neonatologists participated; 71% were women, 84% married, and 75% parents; 91% of physicians rated the simulation as highly realistic. Overall, SDM scores were relatively high, with means ranging from 6.4–7.9 (out of 9). There was a statistically significant interaction between race and insurer for SDM related to steroid use and mode of delivery (p<0.01 and p=0.01, respectively). Between group comparison revealed non-significant differences p=<0.10) between SDM scores for privately-insured black patients vs privately-insured white patients, Medicaid-insured white patients vs Medicaid-insured black patients, and privately-insured black patients vs Medicaid-insured black patients. Conclusions This study confirms that simulation is a feasible method for studying sociodemographic effects on periviable counseling. SDM may occur differentially based on patients’ sociodemographic characteristics and deserves further study.

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Racial and Ethnic Differences in Use of Intubation for Periviable Neonates

Cited by 43 publications

References 37 publications

Variation in classification of live birth with newborn period death versus fetal death at the local level may impact reported infant mortality rate

Variation in classification of live birth with newborn period death versus fetal death at the local level may impact reported infant mortality rate

Attitudes towards the resuscitation of periviable infants: a national survey of American Muslim physicians

Using Simulation to Assess the Influence of Race and Insurer on Shared Decision Making in Periviable Counseling

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