Babies’ race affects quality of care in California neonatal intensive care, study says

Dr. Robert Herzlinger, Director of Neonatology for Yale New Haven Children's Hospital at Bridgeport, works with third year medical student Eun Sook Choi at the hospital's NICU (neonatal intensive care unit) at Bridgeport Hospital in Bridgeport, Conn. on Tuesday Nov. 22, 2015. The Bridgeport Hospital Foundation has launched a campaign to raise the balance of $7 million to modernize the unit. less Dr. Robert Herzlinger, Director of Neonatology for Yale New Haven Children's Hospital at Bridgeport, works with third year medical student Eun Sook Choi at the hospital's NICU (neonatal intensive care unit) at ... more Photo: Christian Abraham, Hearst Connecticut Media Photo: Christian Abraham, Hearst Connecticut Media Image 1 of / 5 Caption Close Babies’ race affects quality of care in California neonatal intensive care, study says 1 / 5 Back to Gallery

An infant’s race and ethnicity affect the quality of care they receive in California neonatal intensive care units, according to a study by the Stanford University School of Medicine.

Asian American and white infants received the highest overall quality of care, according to the scoring system used in the study, which is scheduled to be published Monday in the journal of the American Academy of Pediatrics. African American infants had slightly lower scores compared with Asians and whites. Hispanic infants and infants classified as “other,” which include American Indian and Alaskan Native infants, had significantly lower scores.

Researchers analyzed the quality of care for nearly 19,000 infants in 134 neonatal intensive care units across California — 90 percent of all units in the state — who were born between 2010 and 2014. Previous studies have examined some aspects of care at neonatal intensive care units, or NICUs, but the new Stanford research is the first attempt to look at inequality of care across several dimensions of neonatal intensive care at the same time.

“Significant racial and/or ethnic differences in quality between and within NICUs are a troubling finding,” the study says.

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The disparities, though, are not always clear cut. While white infants scored higher than African American and Hispanic infants in most measures of care, there were some measures where African American and Hispanic infants scored better than whites. There were also significant differences in the quality of treatment among neonatal intensive care units. In some units, white infants received higher quality of care than African American and Hispanic infants. But in other units, the opposite was true.

In general, though, the hospitals with the highest quality care delivered better care to white infants. And African American and Hispanic infants were more likely than white infants to receive care at lower quality neonatal units.

Identifying information about the units that were analyzed was removed from the study, which does not name any of the hospitals involved.

“On a population basis there are general trends — the higher proportion of African American or Hispanic infants in an NICU, the lower the overall quality scores tend to be,” said Dr. Jochen Profit, one of the study’s co-authors. “But even there, there’s a lot of variation where some hospitals we think of as serving a really vulnerable population actually are among the better performers in the state.”

African American and Hispanic babies were less likely to receive some treatments like antenatal steroids — which are administered to pregnant women who are expecting to deliver a preterm baby. They were also less likely to get an an eye exam or human breast milk upon leaving the hospital, the study found. African American and Hispanic babies were also more likely to acquire an infection related to the care they received at the hospital.

However, African American babies were less likely to suffer a collapsed lung, and grew faster than white babies.

The study based its analysis on a composite index known as Baby-Monitor, which includes nine measures of quality of care for infants. The measures include whether the babies or their mothers received specific treatments before or during their stay, or developed harmful conditions after leaving the unit. Those treatments and conditions include antenatal steroid administration, moderate hypothermia, a collapsed lung, bacterial or fungal infections, lung disease, an eye exam, whether they receive human breast milk upon leaving the hospital, mortality during hospitalization and growth rates.

Catherine Ho is a San Francisco Chronicle staff writer. Email: cho@sfchronicle.com Twitter: @Cat_Ho