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For infants diagnosed with bronchopulmonary dysplasia (BPD), being born to a Black mother was associated with a greater likelihood of death and increased length of hospital stay, a cohort study found.

Despite no difference in disease severity by race, Black maternal race was associated with increased odds of death for the child after 36 weeks of postmenstrual age compared to white maternal race (6% vs 3%, adjusted OR 2.1, 95% CI 1.2-3.5), as well as longer hospital stays (median 130 vs 121 days), reported Matthew Kielt, MD, from Nationwide Children's Hospital and The Ohio State University College of Medicine in Columbus, and colleagues.

"Historically, disparate outcomes in neonatal morbidities have been attributed to biologic differences between Black and white patients," the group wrote in . "We posit that the results of our study reflect structural differences in the experience of Black families and the care that Black infants receive in the intensive care unit setting. Structural racism is a root cause for the increased rates of life struggles that Black families in the NICU [neonatal intensive unit care] face."

BPD is the most common serious morbidity of preterm births and affects 50% of infants born at less than 30 weeks of gestation, the authors noted. They went on to explain that the short-term respiratory outcomes of infants with the most severe forms of BPD are highly variable, raising concern about the racial disparity.

The researchers "contribute the largest study focused on the association between race and clinically important outcomes in established severe BPD, bringing attention to racial disparities in a high-risk NICU population," wrote Nicolas Bamat, MD, MSCE, from the Children's Hospital of Philadelphia, and colleagues, in an .

"Further, their findings oppose the central tendency in the literature: that infants of Black mothers have less severe lung disease of prematurity during the birth hospitalization," they added, raising "important questions about when, where, and how exposure to racism begins to shape disparities."

This cohort study used registry data from 834 infants from eight participating U.S. centers from January 2015 to July 2021. To be included, infants needed to have been born at less than 32 weeks of gestation, diagnosed with severe BPD (based on the 2001 NIH Consensus Criteria), and been born to a Black or white mother.

The cohort averaged gestational age 25 weeks at birth. Boys constituted 59% of the group, and a third of the children were born to Black mothers. The babies tended to be born at low birth weights.

When compared with white mothers, Black mothers were more likely to be diagnosed with chorioamnionitis at the time of delivery. Their infants tended to be born smaller and at lower gestational age, and were treated more often with invasive respiratory support such as intubation and surfactant administration.

Kielt's group acknowledged that the study was subject to differences in how centers identified race, and there were no data on paternal race or mother's Hispanic ethnicity. Furthermore, data from referral centers may lack generalizability. There was also a lack of granular data on events surrounding death. Finally, the study may have residual confounding for BPD outcomes, according to the investigators.

They suggested that more research is needed to determine sociodemographic mechanisms underlying differences in health outcomes for infants with severe BPD.

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