Necrotizing enterocolitis (NEC) is one of the most common and serious gastrointestinal complications in the newborn infant, occurring in approximately 1 in 1000 live births. NEC is one of the leading causes of morbidity and mortality in the neonatal intensive care unit. With advances in neonatal care, the diagnosis of NEC has increased. The etiology and pathogenesis are not fully understood given the complexity and multifactorial nature of the disease. There is general consensus that inflammation is a precursor of intestinal ischemia and pneumatosis, causing necrosis and perforation. Low birth weight is one of the most commonly reported risk factors, especially in male infants. Increasing birthweight is associated with decreases in incidence and mortality. In addition, infants of younger gestational age have increased mortality rates. NEC in a full-term infant is usually associated with additional comorbidities such as congenital heart disease or sepsis. NEC is also increased in premature infants receiving early enteral feeding. With respect to race, NEC is associated with disparities in morbidity and mortality that have persisted over many decades. In regards to overall infant mortality, while rates have declined over the past decade, the mortality of black (B) infants has been, and remains, approximately double that of white (W) infants. Maternal characteristics such as education, marital status, and age have been found to contribute to this gap in overall infant mortality. As expected, higher socioeconomic status is associated with better infant health. Finally, among W infants with NEC, maternal age less than 20 years is associated with higher mortality. To explore interrelationships of NEC with mortality, we utilized the United States Centers for Disease Control (CDC) Wide-ranging Online Data for Epidemiologic Research (WONDER) database to describe rates per 100,000 according to gender, race, maternal and infant characteristics. We calculated relative risks (RR) in order to compare B:W mortality from NEC. For overall infant mortality, as expected, the RR for B compared with W infants was about 2.0, a finding that was highly significant. For mortality from NEC, however, the RR for B compared with W infants was about 3.0, a finding that was also statistically significant. With respect to infant mortality from NEC, maternal (marital status, geographic area of residence, pre-natal care) as well as infant characteristics (race, sex, birth weight, gestational age, multiple or single birth, birth order) may affect racial disparities. The current data show greater disparities in B:W infant mortality from NEC than total deaths. These descriptive data support the need for analytic studies designed a priori to test the hypotheses generated by these descriptive data. Such findings should provide important and relevant data to reduce overall and racial disparities in mortality from NEC.
Another Racial Divide: Greater Disparities in Black: White Infant Mortality From Necrotizing Enterocolitis Than Total Deaths
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Ovini D. Rodrigo, Sarah K. Wood, Charles H. Hennekens, Robert S. Levine; Another Racial Divide: Greater Disparities in Black: White Infant Mortality From Necrotizing Enterocolitis Than Total Deaths. Pediatrics August 2019; 144 (2_MeetingAbstract): 609. 10.1542/peds.144.2MA7.609
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