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Inequities in prenatal neonatology consultation in high-mortality neonatal populations
Samantha L Simpson1,2,3,4, Kylie Mena5,6, DonnaMaria E Cortezzo5,7,8,9,10,11,12,13
1Cincinnati Children's Hospital Medical Center, Division of Neonatal and Pulmonary Biology, Cincinnati, OH, USA. Samantha.simpson@cchmc.org.
Insights
Racial and socioeconomic disparities exist in prenatal neonatology consultations for high-mortality conditions. Black, Hispanic, and Medicaid-insured pregnant individuals, along with non-English speakers, received fewer consultations, indicating significant healthcare inequities.
Area of Science:
- Perinatal Medicine
- Health Equity Research
- Neonatal Intensive Care
Background:
- Prenatal consultation is crucial for managing high-mortality conditions in neonates.
- Existing literature suggests potential disparities in healthcare access and quality for vulnerable populations.
Purpose of the Study:
- To investigate inequities in prenatal neonatology consultation and resuscitation decisions.
- To identify disparities among different racial, ethnic, insurance, and language groups.
Main Methods:
- Retrospective chart review of neonates diagnosed with high-mortality conditions.
- Analysis of two cohorts: periviable infants (22-24 weeks gestation) and infants with severe congenital anomalies.
Main Results:
- White pregnant individuals (94%) were more likely to receive consultation than Black individuals (81%).
- Commercial insurance (96%) was associated with higher consultation rates than Medicaid (82%).
- Hispanic pregnant individuals and non-English speakers experienced reduced consultation rates.
Conclusions:
- Significant and previously unrecognized inequities in prenatal neonatology consultation were identified.
- These findings highlight critical areas for improving equitable care in high-risk pregnancies.
Objectives:
To explore inequities in prenatal consultation and parental resuscitation decisions across high-mortality conditions.
Study Design:
We conducted a retrospective chart review of pregnant people whose liveborn neonates were diagnosed with high-mortality conditions. We examined two cohorts: periviable infants (22 0/7-24 6/7 weeks) and infants with severe congenital anomalies.
Results:
A total of 194 neonates met eligibility criteria for the periviable cohort, 197 for the congenital anomaly cohort. In the periviable cohort, 94% of White vs. 81% of Black pregnant people received neonatology consultation (p = 0.009). A total of 96% of those with commercial insurance vs. 82% of those with Medicaid received consultation (p = 0.005). Half of Hispanic pregnant people did not receive neonatology consultation (p = 0.02). In the congenital anomaly cohort, pregnant people who spoke a language other than English were less likely to receive consultation (44% vs. 81%, p = 0.02).
Conclusions:
This regional assessment found previously unrecognized inequities in prenatal neonatology consultation.
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