Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Ethnic differences in risk factors for neonatal mortality and morbidity in the neonatal intensive care unit

Journal of Perinatology volume 27, pages 448–452 (2007)Cite this article

Abstract

Objective:

Although our knowledge about how to care for high-risk neonates who require intensive care is continually improving, disparities in health outcomes among various ethnic groups living in developed countries are becoming more evident. The purpose of this study was to identify the risk factors for neonatal intensive care unit (NICU) mortality among Canadian-born minority infants and, furthermore, to determine whether ethnicity was in itself an independent predictor of mortality or major morbidity in the NICU.

Study design:

Data were prospectively gathered on 6528 infants admitted to nine regionally located NICUs across Canada. Multiple logistic regressions were used to develop risk-adjusted models for NICU mortality and major morbidity.

Result:

Despite adjusting for differences in small for gestational age (SGA), outborn status and gestational age less than or equal to 28 weeks, South Asian infants still had significantly greater odds of mortality in the NICU. Neonatal sepsis was the strongest predictor of mortality among African infants, even greater than birth at 28 weeks or less. At significantly greater odds of survival with major morbidity were Aboriginal males and East Asian females.

Conclusion:

There are ethnic disparities in the risks of neonatal mortality and morbidity in the NICU. Understanding these differences is important to be able to determine specific areas to target in improving healthcare delivery and reducing disparities in health outcomes among Canada's diverse population.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Similar content being viewed by others

References

  1. Chalmers B, Wen SW . Perinatal care in Canada. BMC Women's Health 2004; 25(4): S28.

    Article  Google Scholar 

  2. Ashton D . Prematurity – infant mortality: the scourge remains. Ethn Dis 2006; 16(2 Suppl 3): 58–62.

    Google Scholar 

  3. Lasser KE, Himmelstein DU, Woolhandler S . Access to health, health status, and health disparities in the United States and Canada: results of a cross-national population-based study. Am J Public Health 2006; 96(7): 1300–1307.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Kramer MS, Platt RW, Wen SW, Joseph KS, Allen A, Abrahamowicz M et al. A new and improved population-based Canadian reference for birth weight for gestational age. Pediatrics 2001; 108(2): e35.

    Article  CAS  PubMed  Google Scholar 

  5. Bell MJ, Ternberg JL, Feigin RD, Keating JP, Marshall R, Barton L et al. Neonatal necrotizing enterocolitis: therapeutic decisions based on clinical staging. Ann Surg 1978; 187: 1–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. The Committee for the Classification of Retinopathy of Prematurity. An international classification of retinopathy of prematurity. Arch Ophthalmol 1984; 102(8): 1130–1134.

    Article  Google Scholar 

  7. The Canadian Neonatal NetworkTM. Abstractor's Manual (2004) (user's manual). Available from http://www.canadianneonatalnetwork.org/annual.shtml.

  8. Sharma P, McKay K, Rosenkrantz TS, Hussain N . Comparisons of mortality and pre-discharge respiratory outcomes in small-for-gestational-age and appropriate-for-gestational-age premature infants. BMC Pediatr 2004; 4: 9.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Sankaran K, Chien LY, Walker R, Seshia M, Ohlsson A, Lee SK, the Canadian Neonatal NetworkTM. Variations in mortality rates among Canadian neonatal intensive care units. CMAJ 2002; 166(2): 173–178.

    PubMed  PubMed Central  Google Scholar 

  10. Kierans W, Kramer M, Wilkins R, Liston R, Foster L, Uh S-H et al. 2003 Available from http://www.vs.gov.bc.ca/stats/features/index.html.

  11. von Dadelszen P, Magee LA, Taylor EL, Muir JC, Stewart SD, Sherman P et al. Maternal hypertension and neonatal outcome among small for gestational age infants. Obstet Gynecol 2005; 106(2): 335–339.

    Article  PubMed  Google Scholar 

  12. Liggins GC, Howie RN . A controlled trial of antepartum glucocorticoid treatment for prevention of respiratory distress syndrome in premature infants. Pediatrics 1972; 50: 515–525.

    CAS  PubMed  Google Scholar 

  13. Jacob J, Hulman S, Davis RF, Pfenninger J . Racial differences in newborn intensive care morbidity in Alaska. Alaska Med 2001; 43(2): 32–37.

    CAS  PubMed  Google Scholar 

  14. Harris TR, Isaman J, Giles HR . Improved neonatal survival through maternal transport. Obstet Gynecol 1978; 52: 294–300.

    CAS  PubMed  Google Scholar 

  15. Fiscella K . Racial disparity in infant and maternal mortality: confluence of infection, and microvascular dysfunction. J Child Health 2004; 8(2): 45–54.

    Article  Google Scholar 

  16. Luo ZC, Wilkins R, Platt RW, Kramer MS, for the Canadian Perinatal Surveillance System. Risks of adverse pregnancy outcomes among Inuit and North American Indian women in Quebec, 1985–1997. Paediatr Perinat Epidemiol 2004; 18: 40–50.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

The study was supported by two trainee initiatives: the Neonatal–Perinatal Interdisciplinary Capacity Enhancement (NICE) team and the Strategic Training Initiative in Research in Reproductive Health Sciences (STIRRHS). We acknowledge all the researchers and coordinating staff of the Canadian Neonatal Network for their involvement and commitment to the network.

Author information

Authors and Affiliations

  1. Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada

    J E Claydon

  2. Department of Health Studies, University of British Columbia, Okanagan, Kelowna, BC, Canada

    C Mitton

  3. Department of Pediatrics, University of Saskatchewan, Saskatoon, SK, Canada

    K Sankaran

  4. Department of Pediatrics, University of Alberta, Edmonton, AB, Canada

    S K Lee

  5. Integrated Centre for Care Advancement through Research (iCARE), Edmonton, AB, Canada

    S K Lee

Authors
  1. J E Claydon
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. C Mitton
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. K Sankaran
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. S K Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

Consortia

and the Canadian Neonatal Network™

Corresponding author

Correspondence to J E Claydon.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Claydon, J., Mitton, C., Sankaran, K. et al. Ethnic differences in risk factors for neonatal mortality and morbidity in the neonatal intensive care unit. J Perinatol 27, 448–452 (2007). https://doi.org/10.1038/sj.jp.7211766

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/sj.jp.7211766

Keywords

This article is cited by

Search

Advanced search

Quick links