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.

  • Comment
  • Published:

Expecting equity: reimagining the delivery of racial/ethnic representation in neonatal clinical trials

Journal of Perinatology volume 42, pages 1–2 (2022)Cite this article

Subjects

Execution of obstetric and neonatal care varies widely among institutions across the United States (U.S.). Even within institutions, disparate care practices manifest all the way down to the behaviors of individual healthcare professionals (HCPs) [1]. Some of the factors contributing to these observed differences include the divergent approaches to engagement, assessment, management, and treatment of patients. This matters because certain patients and families experience unjust morbidities and mortalities more often than others do.

Published literature has identified differences across racial subgroups of patients as it relates to the willingness of HCPs to initiate or withhold certain treatment interventions. In a retrospective study involving the 776 Vermont Oxford Network centers, Boghossian et al. observed that, for neonates born at <24 weeks of gestation in the U.S. Northeast region, neonates of Black parents more frequently received life-sustaining interventions (e.g., endotracheal tube, mechanical ventilation, and surfactant therapy) as compared to the neonates born to white parents (adjusted risk ratio [aRR]: 1.84; 99% confidence interval [CI] 1.33–2.56). A comparison of neonates born to Black versus Hispanic parents (aRR 1.80; CI: 1.23–2.64] yielded similar results [2]. A recent study of all U.S. live births for neonates born at <24 weeks gestation also demonstrated that Black infants received higher rates of neonatal critical care interventions (e.g., neonatal intensive care unit admission, surfactant administration, and assisted ventilation). Conversely, the study identified a negative association between Black obstetrical patients and the implementation of medical treatments such as Cesarean delivery and antenatal corticosteroid administration [3]. The racialized biases observed in these and other studies [4, 5] raise concerns as to why more aggressive interventions for extremely premature Black babies fail to yield equitable health outcomes when compared to those babies of other racial/ethnic identities.

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

References

  1. Rysavy MA, Li L, Bell EF, Das A, Hintz SR, Stoll BJ, et al. Between-hospital variation in treatment and outcomes in extremely preterm infants. N Engl J Med. 2015;372:1801–11.

    Article  Google Scholar 

  2. Boghossian NS, Geraci M, Edwards EM, Ehret DEY, Saade GR, Horbar JD. Regional and racial-ethnic differences in perinatal interventions among periviable births. Obstet Gynecol. 2020;135:885–95.

    Article  Google Scholar 

  3. Hajdu SA, Rossi RM, DeFranco EA. Factors associated with maternal and neonatal interventions at the threshold of viability. Obstet Gynecol. 2020;135:1398–408.

    Article  Google Scholar 

  4. Hall WJ, Chapman MV, Lee KM, Merino YM, Thomas TW, Payne BK, et al. Implicit racial/ethnic bias among health care professionals and its influence on health care outcomes: a systematic review. Am J Public Health. 2015;105:e60–76.

    Article  Google Scholar 

  5. Johnson TJ. Racial bias and its impact on children and adolescents. Pediatr Clin North Am. 2020;67:425–36.

    Article  Google Scholar 

  6. Saluja B, Bryant Z. How implicit bias contributes to racial disparities in maternal morbidity and mortality in the United States. J Womens Health. 2021;30:270–3.

    Article  Google Scholar 

  7. Centers for Disease Control and Prevention Office of Minority Health & Health Equity (OMHHE). Health Equity; Minority Health and Health Equity: U.S. Department of Health & Human Services. 2021. https://www.cdc.gov/healthequity/racism-disparities/index.html.

  8. Khan A, McHugh C, Conomos MP, Gogarten SM, Nelson SC, Group RaGD. Guidelines on the use and reporting of race, ethnicity, and ancestry in the NHLBI Trans-Omics for Precision Medicine (TOPMed) program: University of Washington Department of Biostatistics. 2021. https://www.nhlbiwgs.org/guidelines-use-and-reporting-race-ethnicity-and-ancestry-topmed.

  9. Breathett K, Spatz ES, Kramer DB, Essien UR, Wadhera RK, Peterson PN, et al. The groundwater of racial and ethnic disparities research: a statement from circulation: cardiovascular quality and outcomes. Circ Cardiovasc Qual Outcomes. 2021;14:e007868.

    Article  Google Scholar 

  10. Boyd RW, Lindo EG, Weeks LD, McLemore MR. On racism: a new standard for publishing on racial health inequities. Health Affairs. Bethesda, MD: Health Affairs Journal; 2020.

  11. Weiss EM, Olszewski AE, Guttmann KF, Magnus BE, Li S, Shah AR, et al. Parental factors associated with the decision to participate in a neonatal clinical trial. JAMA Netw Open. 2021;4:e2032106.

    Article  Google Scholar 

  12. Tucker Edmonds B, Fager C, Srinivas S, Lorch S. Racial and ethnic differences in use of intubation for periviable neonates. Pediatrics. 2011;127:e1120–7. https://doi.org/10.1542/peds.2010-2608.

    Article  PubMed  Google Scholar 

  13. Burris HH, Duncan AF. Rethinking how to persuade more parents from diverse or disadvantaged backgrounds to enroll infants in neonatal clinical trials. JAMA Netw Open. 2021;4:e2032137.

    Article  Google Scholar 

  14. Pavlek LR, Rivera BK, Smith CV, Randle J, Hanlon C, Small K, et al. Eligibility criteria and representativeness of randomized clinical trials that include infants born extremely premature: a systematic review. J Pediatr. 2021;235:63–74.e12.

    Article  Google Scholar 

Download references

Funding

Ohio Perinatal Research Network (OPRN) within the Abigail Wexner Research Institute at Nationwide Children’s Hospital.

Author information

Authors and Affiliations

  1. Department of Pediatrics, The Ohio State University Wexner Medical Center, Columbus, OH, USA

    Valencia P. Walker, Leeann R. Pavlek & Carl H. Backes

  2. Center for Perinatal Research, The Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH, USA

    Leeann R. Pavlek & Carl H. Backes

  3. Ohio Perinatal Research Network, Nationwide Children’s Hospital, Columbus, OH, USA

    Leeann R. Pavlek & Carl H. Backes

  4. The Heart Center, Nationwide Children’s Hospital, Columbus, OH, USA

    Carl H. Backes

  5. Department of Obstetrics and Gynecology, The Ohio State University Wexner Medical Center, Columbus, OH, USA

    Carl H. Backes

Authors
  1. Valencia P. Walker
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Leeann R. Pavlek
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Carl H. Backes
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

VPW, LRP and CHB were involved in drafting the editorial, revising it critically for important intellectual content, and approved the submission.

Corresponding author

Correspondence to Carl H. Backes.

Ethics declarations

Competing interests

The authors declare no competing interests.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Walker, V.P., Pavlek, L.R. & Backes, C.H. Expecting equity: reimagining the delivery of racial/ethnic representation in neonatal clinical trials. J Perinatol 42, 1–2 (2022). https://doi.org/10.1038/s41372-021-01225-0

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41372-021-01225-0

Search

Advanced search

Quick links