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J Pediatr. 2014 May;164(5):1005-1011.e3. doi: 10.1016/j.jpeds.2014.01.036. Epub 2014 Feb 28.

Maternal race, demography, and health care disparities impact risk for intraventricular hemorrhage in preterm neonates.

Author information

1
Department of Pediatrics, Wayne State University School of Medicine, Detroit, MI. Electronic address: sshankar@med.wayne.edu.
2
Department of Pediatrics, Yale University School of Medicine, New Haven, CT.
3
Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven, CT.
4
Department of Pediatrics, Wake Forest School of Medicine, Winston Salem, NC.
5
Department of Pediatrics, University of Kentucky College of Medicine, Lexington, KY.
6
Departments of Pediatrics and Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX.
7
Department of Genetics and the Howard Hughes Medical Institute, Yale University School of Medicine, New Haven, CT.
8
Department of Pediatrics, University of Miami Miller School of Medicine, Miami, FL.
9
Department of Pediatrics, Yale University School of Medicine, New Haven, CT; Department of Neurology, Yale University School of Medicine, New Haven, CT.

Abstract

OBJECTIVE:

To determine whether risk factors associated with grade 2-4 intraventricular hemorrhage (IVH) differs between infants of African ancestry and white infants.

STUDY DESIGN:

Inborn, appropriate for gestational age infants with birth weight 500-1250 g and exposure to at least 1 dose of antenatal steroids were enrolled in 24 neonatal intensive care units. Cases had grade 2-4 IVH and controls matched for site, race, and birth weight range had 2 normal ultrasounds read centrally. Multivariate logistic regression modeling identified factors associated with IVH across African ancestry and white race.

RESULTS:

Subjects included 579 African ancestry or white race infants with grade 2-4 IVH and 532 controls. Mothers of African ancestry children were less educated, and white case mothers were more likely to have more than 1 prenatal visit and multiple gestation (P ≤ .01 for all). Increasing gestational age (P = .01), preeclampsia (P < .001), complete antenatal steroid exposure (P = .02), cesarean delivery (P < .001), and white race (P = .01) were associated with decreased risk for IVH. Chorioamnionitis (P = .01), 5-minute Apgar score <3 (P < .004), surfactant use (P < .001), and high-frequency ventilation (P < .001) were associated with increased risk for IVH. Among African ancestry infants, having more than 1 prenatal visit was associated with decreased risk (P = .02). Among white infants, multiple gestation was associated with increased risk (P < .001), and higher maternal education was associated with decreased risk (P < .05).

CONCLUSION:

The risk for IVH differs between infants of African ancestry and white infants, possibly attributable to both race and health care disparities.

PMID:
24589078
PMCID:
PMC4095864
DOI:
10.1016/j.jpeds.2014.01.036
[Indexed for MEDLINE]
Free PMC Article
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