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Yet, "our study estimates the risk of morbidity very premature from the point of view of all pregnancies and, therefore, allows to better grasp the disparities at the level of the population," said Janevic.
"The magnitude of the disparities is striking"
In the new study, "we were not surprised to find that black and Hispanic infants have a higher risk of very premature morbidity, given what we know of their increased risk of being born extremely premature, may play a role in racial and ethnic disparities in very premature morbidity, "said Janevic.
"However, the magnitude of the disparities is striking," she said. "In addition, we were somewhat surprised by the discovery of an increased risk of retinopathy of prematurity in very premature newborns in Asia, a finding that needs to be further explored to replicate and potentially explain."
The new study looked at 582,297 infants in New York City who were born prematurely, between 24 and 31 weeks of gestation, between 2010 and 2014, and then died between 2010 and 2015.
Researchers analyzed the prevalence of four serious neonatal morbidities in the data, closely examining differences by race and ethnicity.
Once the researchers adjusted the data for various factors – such as socio-economic status or maternal health – they found that black infants had an increased risk of bronchopulmonary dysplasia and necrotizing enterocolitis.
The researchers found that Hispanic infants presented an increased risk of necrotizing enterocolitis and intraventricular hemorrhage and that Asian infants presented an increased risk of retinopathy.
The study had certain limitations, including the fact that the diagnosis of morbidities as well as coding practices could vary from one hospital to another and that the researchers had not been able to do so. detailed information in the medical records for each child to explain the reasons for these disparities.
Further research is needed to determine exactly what factors are causing these disparities, but Janevic came up with some ideas.
"The quality of care for both the mother and the very premature baby probably plays a role, as does a wide range of social, environmental and biological exposures to the developing fetus," she said. "In our study, black and Hispanic infants were more likely to be born very premature than white infants, which partly explains the large disparities in morbidity."
"These results … should lead us to redouble our efforts"
Thus, the health disparity observed in premature infants may be related to the health disparities also observed among pregnant women.
In pregnant women, "there is growing evidence that chronic stress associated with poverty and discrimination can lead to behavioral changes, including substance use, but also biological changes in inflammation, function, neuroendocrine and risk of prematurity, "said Kramer, who did not participate in the study.
"There is no evidence in this study that shorter gestation for black women is entirely normal," Kramer said. "On the contrary, these findings of very large racial and ethnic disparities should lead us to redouble our efforts to understand not only the biological, but also the behavioral and social determinants of racial differences in health."
Reversing an idea commonly received
Now, the new study "really argues that it's not true, that African-American infants are not doing better and can even do worse than their white counterparts," Burris said.
As to why this disparity exists, there are many potential explanations, she said.
"One could be on the side of health care, in other words, what doctors and nurses do.Are there any differences of care resulting from potential cultural practices, or even implicit prejudices? Is a hypothesis, "said Burris.
Another possible factor could be the reason why a premature delivery took place in the first place. If the reason was a certain pregnancy complication that varies by race, this complication could contribute to a higher risk of infant morbidity, which could subsequently vary from one breed to another.
However, in general, this disparity in premature newborns remains difficult to examine because "the other part is that death is not a random event in the NICU most of the time" said Burris.
"The way most babies die in the neonatal intensive care unit, is that they have a complication and the decision is then made to stop the intensive care and provide comfort care, "she said. "There may be potential racial disparities in this practice, making these data somewhat difficult to interpret.This is a limitation of all outcome studies in premature newborns because it is safe to use. 39, is an individual conversation between the family and the provider. "
"We know that there are disparities in the number of babies born before term and that being born too early often leads to poorer birth outcomes." The results of this article have a logical meaning: disparities similar in severe neonatal morbidities also occur ". . "This report reinforces the urgency of supporting women before, during and after pregnancy and preventing premature births in women of color and all women."
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