A recent study published in JAMA Pediatrics reveals significant racial disparities in discussions about redirecting care for extremely preterm infants. Redirection of care, a critical process involving conversations about shifting from intensive, life-sustaining treatments to comfort-focused care, occurred less frequently for Black and Hispanic infants compared to White and non-Hispanic infants.
The study, conducted by the National Institute of Child Health and Human Development Neonatal Research Network, examined approximately 15,600 infants born before 29 weeks of gestation between April 2011 and December 2020. Researchers investigated whether infant care was redirected based on maternal social determinants and assessed death rates and impaired neurodevelopment at 22 to 26 months of age.
After controlling for various factors, the findings showed that infants of Black mothers had 16% lower odds of redirection of care discussions compared to infants of White mothers. For Hispanic mothers, these discussions were almost 30% less likely than for non-Hispanic mothers. The actual implementation of redirected care occurred 25% less often for Black infants and 35% less often for Hispanic infants.
These discussions are crucial as they help families and medical teams make informed decisions about the most appropriate care for extremely premature infants, who often face significant health challenges. The disparity in these conversations could potentially impact long-term outcomes and quality of life for these vulnerable infants.
The study underscores the need to address racial and ethnic disparities in neonatal care decision-making processes. While the reasons behind these disparities require further investigation, the findings highlight potential differences in physician-patient interactions based on social determinants of health. This research emphasizes the importance of equitable healthcare practices and the need for increased awareness of racial disparities in critical care discussions.
See “For infants born extremely preterm, redirection of care discussions occurred less often for Black and Hispanic infants” (March 12, 2024)
