Disparities in Survival Without Major Morbidity Among Very Low Birth Weight Infants in California

Very low birth weight infants in the NICU are more susceptible to adverse outcomes. We recently described improving survival without major morbidity among very low birth weight infants in California. This study aims to examine whether this improvement was equitable across racial and ethnic groups.

We included 66 786 infants from the California Perinatal Quality Care Collaborative who weighed <1500 grams or were <29 weeks' gestational age at birth and were cared for between January 1, 2008 and December 31, 2021. We examined rates of survival without major morbidity over time, stratified by safety net NICUs (snNICUs), as well as racial and ethnic groups.

Between 2008 and 2021, survival without major morbidity increased from 62.2% to 66.1% (P < .001), although improvement plateaued after 2017. All racial and ethnic groups saw improvement, with Native Hawaiian/Pacific Islander and Black infants improving the most (12.4% and 9.8%, respectively). However, during the last 3 years, Hispanic infants had the lowest rates of survival without major morbidity (64.3%), compared with non-Hispanic white (67.6%), Black (67.8%), Asian (68.9%), Native Hawaiian/Pacific Islander (68.5%), and American Indian/Alaskan Native (69.9%) infants. Black and Hispanic infants were disproportionately cared for in snNICUs, which experienced significantly lower survival without major morbidity than non-snNICUs at all time points.

We observed improvement in survival without major morbidity over 14 years, with progress stalling in recent years. Opportunities to address health inequities in NICU outcomes remain, particularly in snNICUs, while identifying strategies for continued improvement overall.