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Race and Ethnicity of Sick Babies Changes the Quality of their NICU Care

The neonatal intensive care unit is no place for racial biases, or at least it shouldn't be.

Hispanic infants and other minority children may be getting inferior care at neonatal intensive care units, a new study suggests. The researchers found that Hispanic, American Indian, Alaskan Native and other minority babies had lower “quality of care” scores than white, black, and Asian infants in California NICUs. The results also suggest that improved parent-provider communication could help close these gaps, and curb the consequences of unconscious biases.

“We were interested in looking at the areas related to disparity and health care that we could directly influence,” study coauthor Jochen Profit, neonatologist and professor of pediatrics at Stanford University, told Fatherly. Prior work on healthcare disparities in NICUs had largely focused on factors that doctors cannot prevent, such as socioeconomic status (areas with high poverty and crime rates are always under-served). “As neonatologists…we wanted to shine a light on where there were disparities after babies were born, and whether we can address this as a profession.”

As far as racial bias goes, preliminary studies have shown that African American and Hispanic infants are more likely to receive care poor-quality care in NICUs. Studies have attributed this to lack of access, often as a result of poverty, but more up-to-date research suggests that even once they’re in the hospital, minority children are treated differently. Studies suggest that black and hispanic premature infants who are admitted to the NICU receive fewer antenatal steroids in the hospital and less breast milk at discharge. But this is the first study to examine overall quality of care.

For this study—a retrospective analysis based on a population of 18,616 babies across 134 hospitals in California—Profit and his team assessed quality of care for each infant using a nine-item scale, which measures of chronic lung disease, growth velocity, all steroid administration, and mortality, among other factors. Researchers controlled for specific hospitals that had generally bad NICU outcomes, length of the mother’s pregnancy, and other risk factors to try to ensure that all children analyzed were about equally sick. “We tried to compare apples with apples,” Profit says.

The researchers found that Hispanic, American Indian, and Alaskan Native babies had lower scores on the non-item scale than white, African American, and Asian American infants. That surprised Profit, but not nearly as much as the wide variation in quality of care that he found across all NICUs—implying bias is only one in a sea of problems. “Race and ethnicity appear to be one of the factors contributing to that variation, but it’s really not uniform,” he says.

The study comes with several caveats—it’s retrospective, controlling such a study is difficult, and the analysis did not take poverty into account even though it’s a substantial risk factor for negative outcomes—so Profit stresses that we cannot draw conclusions about actual biases held by healthcare providers. And he suspects that, if unconscious biases are at play, most physicians are self-aware enough to identify the problem and fix it, once it has been pointed out.

“I don’t think any health care professionals are going to work and deciding to give lesser care to sick infants based on biases,” Profit says.