Question

What is the largest effect of disparities in the newborn/infant population?

Answer 1

Introduction

Like health disparities in US adults, the disadvantage in cause-specific death rates for Black infants compared with White infants is distributed across nearly all causes. Racial disparity in infant deaths is highest for deaths related to prematurity and lowest for birth defects and chromosomal disorders.

Infant mortality is the death of an infant before his or her first birthday. The infant mortality rate is the number of infant deaths for every 1,000 live births. In addition to giving us key information about maternal and infant health, the infant mortality rate is an important marker of the overall health of a society. In 2018, the infant mortality rate in the United States was 5.7 deaths per 1,000 live births.

Causes of Infant Mortality

The five leading causes of infant death in 2018 were: Birth defects. Preterm birth and low birth weight. Maternal pregnancy complications.

Birth Defects

Congenital heart defects, central nervous system (CNS) birth defects, and chromosome abnormalities together account for 67% of neonatal mortality from birth defects and 79% of total postneonatal mortality from birth defects . Neonatal mortality from birth defects for all three causes is significantly lower for non-Hispanic black infants compared with non-Hispanic white infants, but since 1989, postneonatal mortality rates have been significantly higher, mainly from an increase in deaths due to heart defects . Neonatal mortality rates for Hispanic infants are higher for CNS birth defects. Postneonatal mortality rates of Hispanic infants are higher for chromosomal abnormalities compared with those of non-Hispanic white infants, and higher mortality rates for heart defects and CNS defects have emerged since 1989

Preterm-Related Deaths

Strong evidence demonstrates that surfactant and antenatal steroids for preterm labor reduce preterm-related deaths. Recent clinical trials show that progesterone therapy throughout pregnancy reduces preterm birth, and hence could reduce preterm-related deaths . Several studies indicate that CenteringPregnancy may be a useful population-based strategy for reducing preterm births among low-risk women . The overall death rate from RDS has improved dramatically since the early 1990s when surfactant replacement therapy for preterm newborns became available; however, disparities in mortality from RDS have emerged since that time. Black infants shifted from a survival advantage in RDS to being 2.7 times as likely to die from RDS. In 2007, RDS mortality was 43 per 100,000 live births for non-Hispanic black infants and 12.3 per 100,000 live births for non-Hispanic white infants