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Racial and Ethnic Inequities in Therapeutic Hypothermia and Neonatal Hypoxic-Ischemic Encephalopathy: A Retrospective Cohort Study.
Fall, Carolyn; Baer, Rebecca J; Jelliffe-Pawlowski, Laura; Matoba, Nana; Lee, Henry C; Chambers, Christina D; Bandoli, Gretchen.
Afiliação
  • Fall C; Rady Children's Hospital of San Diego, University of California, San Diego, San Diego, CA.
  • Baer RJ; Division of Pediatrics, University of California San Diego, San Diego, CA; Division of Epidemiology, Biostatistics, University of California San Francisco, San Francisco, CA.
  • Jelliffe-Pawlowski L; Division of Epidemiology, Biostatistics, University of California San Francisco, San Francisco, CA.
  • Matoba N; Rady Children's Hospital of San Diego, University of California, San Diego, San Diego, CA.
  • Lee HC; Rady Children's Hospital of San Diego, University of California, San Diego, San Diego, CA.
  • Chambers CD; Rady Children's Hospital of San Diego, University of California, San Diego, San Diego, CA.
  • Bandoli G; Rady Children's Hospital of San Diego, University of California, San Diego, San Diego, CA.
J Pediatr ; 269: 113966, 2024 Jun.
Article em En | MEDLINE | ID: mdl-38369239
ABSTRACT

OBJECTIVE:

To investigate racial inequities in the use of therapeutic hypothermia (TH) and outcomes in infants with hypoxic-ischemic encephalopathy (HIE). STUDY

DESIGN:

We queried an administrative birth cohort of mother-baby pairs in California from 2010 through 2019 using International Classification of Diseases codes to evaluate the association between race and ethnicity and the application of TH in infants with HIE. We identified 4779 infants with HIE. Log-linear regression was used to calculate risk ratios (RR) for TH, adjusting for hospital transfer, rural location, gestational age between 35 and 37 weeks, and HIE severity. Risk of adverse infant outcome was calculated by race and ethnicity and stratified by TH.

RESULTS:

From our identified cohort, 1338 (28.0%) neonates underwent TH. White infants were used as the reference sample, and 410 (28.4%) received TH. Black infants were significantly less likely to receive TH with 74 (20.0%) with an adjusted risk ratio (aRR) of 0.7 (95% CI 0.5-0.9). Black infants with any HIE who did not receive TH were more likely to have a hospital readmission (aRR 1.36, 95% CI 1.10-1.68) and a tracheostomy (aRR 3.07, 95% CI 1.19-7.97). Black infants with moderate/severe HIE who did not receive TH were more likely to have cerebral palsy (aRR 2.72, 95% CI 1.07-6.91).

CONCLUSIONS:

In this study cohort, Black infants with HIE were significantly less likely to receive TH. Black infants also had significantly increased risk of some adverse outcomes of HIE. Possible reasons for this inequity include systemic barriers to care and systemic bias.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Hipóxia-Isquemia Encefálica / Disparidades em Assistência à Saúde / Hipotermia Induzida Limite: Female / Humans / Male / Newborn País/Região como assunto: America do norte Idioma: En Revista: J Pediatr Ano de publicação: 2024 Tipo de documento: Article País de publicação: Estados Unidos
Texto completo
Adicionar na Minha BVS
Imprimir
XML
PubMed Links
Buscar no Google

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Hipóxia-Isquemia Encefálica / Disparidades em Assistência à Saúde / Hipotermia Induzida Limite: Female / Humans / Male / Newborn País/Região como assunto: America do norte Idioma: En Revista: J Pediatr Ano de publicação: 2024 Tipo de documento: Article País de publicação: Estados Unidos