Maternal race, demography, and health care disparities impact risk for intraventricular hemorrhage in preterm neonates

J Pediatr. 2014 May;164(5):1005-1011.e3. doi: 10.1016/j.jpeds.2014.01.036. Epub 2014 Feb 28.


Objective: To determine whether risk factors associated with grade 2-4 intraventricular hemorrhage (IVH) differs between infants of African ancestry and white infants.

Study design: Inborn, appropriate for gestational age infants with birth weight 500-1250 g and exposure to at least 1 dose of antenatal steroids were enrolled in 24 neonatal intensive care units. Cases had grade 2-4 IVH and controls matched for site, race, and birth weight range had 2 normal ultrasounds read centrally. Multivariate logistic regression modeling identified factors associated with IVH across African ancestry and white race.

Results: Subjects included 579 African ancestry or white race infants with grade 2-4 IVH and 532 controls. Mothers of African ancestry children were less educated, and white case mothers were more likely to have more than 1 prenatal visit and multiple gestation (P ≤ .01 for all). Increasing gestational age (P = .01), preeclampsia (P < .001), complete antenatal steroid exposure (P = .02), cesarean delivery (P < .001), and white race (P = .01) were associated with decreased risk for IVH. Chorioamnionitis (P = .01), 5-minute Apgar score <3 (P < .004), surfactant use (P < .001), and high-frequency ventilation (P < .001) were associated with increased risk for IVH. Among African ancestry infants, having more than 1 prenatal visit was associated with decreased risk (P = .02). Among white infants, multiple gestation was associated with increased risk (P < .001), and higher maternal education was associated with decreased risk (P < .05).

Conclusion: The risk for IVH differs between infants of African ancestry and white infants, possibly attributable to both race and health care disparities.

Publication types

  • Multicenter Study
  • Research Support, N.I.H., Extramural

MeSH terms

  • Black People*
  • Black or African American
  • Case-Control Studies
  • Cerebral Hemorrhage / diagnostic imaging
  • Cerebral Hemorrhage / ethnology
  • Cerebral Hemorrhage / etiology*
  • Female
  • Healthcare Disparities*
  • Humans
  • Infant, Newborn
  • Infant, Premature
  • Infant, Premature, Diseases / diagnostic imaging
  • Infant, Premature, Diseases / ethnology
  • Infant, Premature, Diseases / etiology*
  • Logistic Models
  • Male
  • Multivariate Analysis
  • Pregnancy
  • Prenatal Care
  • Risk Factors
  • Socioeconomic Factors
  • Sweden / epidemiology
  • Ultrasonography
  • United States / epidemiology
  • White People*