Racial Disparity In Care Starts With Youngest, Frailest Patients

The review, of 41 studies, found that infants created to minority women typically received poorer treatment in the neonatal intensive care device (NICU) compared with white newborns. The finding was often related to lower-quality care in hospitals where minorities made up a large talk about of patients. But studies also have found treatment disparities within the same NICU. Dr. Jochen Profit, a co-employee professor of pediatrics at Stanford University, in California.

But, he said, “NICUs don’t can be found in a vacuum,” and can be at the mercy of the same biases seen else almost everywhere. In general, the review found, black preterm infants were most vulnerable: Hospitals with a high percentage of black preemies typically had lower-quality care and fewer nurses, versus those with a smaller percentage of black patients.

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There was also evidence that newborn death rates were higher in those “minority-serving” NICUs. It’s a pattern that played out in a recent research of 700 NICUs, where researchers found that dark preemies were concentrated in centers with lower-quality care-compared with white, Hispanic, and Asian babies. Quality of care was ranked according to factors like newborn death rates, and the chance of a preemie developing infections, lung problems, or hypothermia (an abrupt drop in body temperature).

Part of the problem is insufficient resources and understaffing at minority-serving clinics, according to Profit. But, he said, there’s also racial disparities in treatment “processes.” In some studies, for example, parents of black and Hispanic preemies were less inclined to get referrals for follow-up care after their NICU discharge, weighed against whites. And over the years, one critical gap has been around the use of surfactant therapy, regarding Dr. Wanda Barfield, of the U.S. Centers for Disease Prevention and Control. Normally, the body produces its surfactant, a liquid that coats the lungs and keeps them from collapsing. When babies are delivered before the lungs have completely developed, surfactant replacement unit therapy can be lifesaving, Barfield explained.

But some studies have discovered that dark preemies were less likely to receive surfactant than white newborns. According to Barfield, there’s historically been a “myth” that dark preemies have a more positive view, versus other groups. That’s rooted in a statistic: At any given birth weight, aside from the littlest newborns, black babies generally have better success rates.

But such wide patterns should not affect care decisions for any one baby, Barfield said. She wrote an editorial released online with the review July 29 in Pediatrics. Besides some distinctions in treatment, the review also found that minority families tended to be less satisfied with their NICU experience. Studies have found that black mothers are less inclined to be breastfeeding when their baby is discharged from the NICU-and that those moms reported less education and support for breastfeeding, both before and after giving birth.

In one research, black women were more likely to say they were discouraged from “kangaroo care” -having daily skin-to-skin connection with their newborn that, among other benefits, stimulates breastfeeding. Often, minority parents feel like they’re “not being heard,” Barfield said. Profit agreed. In some cases, he said, there are language barriers.