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

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.