Racial and ethnic differences in use of intubation for periviable neonates

Racial/ethnic minorities report preferences for resuscitative care at the end of life. The main objective of this study was to determine if there are racial/ethnic differences in use of intubation for periviable neonates. We hypothesized that infants born to black and Hispanic women are more likely to be resuscitated compared with infants born to white women.

We conducted a retrospective cohort study of state-level maternal and infant hospital discharge data of women who delivered between 23.0 and 24.6 weeks' gestation linked to birth and death certificate data for California, Missouri, and Pennsylvania from 1995 to 2005 (N = 9632).

Overall, 78.9% of the population was aged 18 to 35 years, and almost half were nulliparous; 19.4% of the women were black, 36.6% were Hispanic, and 33.4% were white. Approximately 30% had less than a high school education, and 49.2% were federally insured. Overall, 44.7% of periviable neonates were intubated. In multivariable analyses adjusting for sociodemographic characteristics, black and Hispanic race/ethnicity was significantly associated with neonatal intubation (odds ratios [ORs]: 1.14 [95% confidence interval (CI): 1.01-1.29] and 1.22 [95% CI: 1.10-1.36], respectively). In models controlling for clustering at the level of the delivery hospital, black race remained a predictor of neonatal intubation (OR: 1.25 [95% CI: 1.07-1.46]), but differences among Hispanics dissipated (OR: 1.12 [95% CI: 0.98-1.27]).

Racial/ethnic differences exist in patterns of periviable resuscitation, which may reflect underlying differences in patient preference. Alternatively, institutional practices or resources may account for these differences. These findings have important implications for patient care and institutional practice. Our results lay the foundation for additional work to investigate how social, cultural, and institutional factors influence patient-provider decision-making regarding periviable care.