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Racial/ethnic differences in necrotizing enterocolitis incidence and outcomes in premature very low birth weight infants

Journal of Perinatology volume 38, pages 1386–1390 (2018)Cite this article

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Abstract

Background

As advances in neonatal intensive care increase the survival of extremely premature infants, the at-risk population for necrotizing enterocolitis (NEC) continues to rise. Although racial health disparities in preterm births have been well documented, large-scale studies exploring racial differences in NEC outcomes are lacking. Here, we conduct a study of racial health disparities in NEC using a nationally representative multicenter cohort.

Study design

Infants ≤1500 g birth weight and ≤30 weeks gestational age admitted in the first week after birth to neonatal intensive care units in the Pediatrix Medical group from 1997 to 2015 were included. Multivariable logistic regression was used to determine the adjusted odds ratio (AOR) of risk factors related to NEC and associated mortality.

Results

Of the 126,089 (45% non-Hispanic White, 27% non-Hispanic Black, and 19% Hispanic) infants who met the inclusion criteria, 8796 (7%) developed NEC. On multivariable analysis, non-Hispanic Black and Hispanic infants had higher odds of developing NEC (AOR 1.31, 95% confidence interval (CI) [1.24–1.39], p < 0.001 and AOR 1.30 [1.21–1.39], p < 0.001, respectively). Among infants with NEC, mortality was higher in non-Hispanic Black and Hispanic infants compared to non-Hispanic White infants (AOR 1.35 [1.15–1.58], p < 0.001 and AOR 1.31 [1.09–1.56], p = 0.003, respectively).

Conclusion

Our study demonstrates that non-Hispanic Black and Hispanic infants are significantly more likely to be diagnosed with NEC. In addition, non-Hispanic Black and Hispanic infants have higher odds of death after NEC compared to non-Hispanic White infants. Further studies are necessary to investigate the etiology of these health disparities and to test interventions to improve these health outcomes.

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Acknowledgements

We are grateful to the Pediatrix Medical Group member NICUs for contributing data used in this study.

Author contributions

MLJ and OOA conceptualized and designed this study, drafted the initial manuscript, and reviewed and revised the manuscript. RGG carried out the initial analysis and reviewed and revised the manuscript. PBS, HER, and ETT contributed to the analysis and interpretation of data and provided critical review of the manuscript. RHC collected data, contributed to the analysis and interpretation of the data, and provided critical review of the manuscript. All authors approved the final manuscript as submitted and agree to be accountable for all aspects.

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Authors and Affiliations

  1. Duke University School of Medicine, Durham, NC, USA

    Momodou L. Jammeh

  2. Division of Pediatric Surgery, Department of Surgery, Duke University Medical Center, Durham, NC, USA

    Obinna O. Adibe, Elisabeth T. Tracy & Henry E. Rice

  3. Pediatrix-Obstetrix Center for Research and Education, Sunrise, FL, USA

    Reese H. Clark

  4. Duke Clinical Research Institute, Durham, NC, USA

    P. Brian Smith & Rachel G. Greenberg

  5. Department of Pediatrics, Duke University Medical Center, Durham, NC, USA

    P. Brian Smith & Rachel G. Greenberg

Authors
  1. Momodou L. Jammeh
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  2. Obinna O. Adibe
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Correspondence to Rachel G. Greenberg.

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The authors declare that they have no conflict of interest.

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Jammeh, M.L., Adibe, O.O., Tracy, E.T. et al. Racial/ethnic differences in necrotizing enterocolitis incidence and outcomes in premature very low birth weight infants. J Perinatol 38, 1386–1390 (2018). https://doi.org/10.1038/s41372-018-0184-x

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