BACKGROUND AND OBJECTIVES Very low birth weight infants in the NICU are more susceptible to adverse outcomes. We recently described improving survival without major morbidity among very low birth weight infants in California. This study aims to examine whether this improvement was equitable across racial and ethnic groups. METHODS We included 66 786 infants from the California Perinatal Quality Care Collaborative who weighed <1500 grams or were <29 weeks' gestational age at birth and were cared for between January 1, 2008 and December 31, 2021. We examined rates of survival without major morbidity over time, stratified by safety net NICUs (snNICUs), as well as racial and ethnic groups. RESULTS Between 2008 and 2021, survival without major morbidity increased from 62.2% to 66.1% (P < .001), although improvement plateaued after 2017. All racial and ethnic groups saw improvement, with Native Hawaiian/Pacific Islander and Black infants improving the most (12.4% and 9.8%, respectively). However, during the last 3 years, Hispanic infants had the lowest rates of survival without major morbidity (64.3%), compared with non-Hispanic white (67.6%), Black (67.8%), Asian (68.9%), Native Hawaiian/Pacific Islander (68.5%), and American Indian/Alaskan Native (69.9%) infants. Black and Hispanic infants were disproportionately cared for in snNICUs, which experienced significantly lower survival without major morbidity than non-snNICUs at all time points. CONCLUSIONS We observed improvement in survival without major morbidity over 14 years, with progress stalling in recent years. Opportunities to address health inequities in NICU outcomes remain, particularly in snNICUs, while identifying strategies for continued improvement overall.

中文翻译：

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加利福尼亚极低出生体重婴儿无重大并发症的生存率差异。


背景和目的 NICU 中的极低出生体重婴儿更容易出现不良结局。我们最近描述了提高加利福尼亚极低出生体重婴儿的存活率，而没有重大发病率。本研究旨在检查这种改善在种族和民族群体之间是否公平。方法 我们纳入了来自加利福尼亚围产期质量护理合作组织的 66 786 名婴儿，这些婴儿出生时体重 <1500 克或胎龄为 <29 周，并在 2008 年 1 月 1 日至 2021 年 12 月 31 日期间接受了护理。我们检查了随时间推移无重大发病率的生存率，按安全网 NICU （snNICU） 以及种族和民族群体分层。结果 2008 年至 2021 年期间，无重大并发症的生存率从 62.2% 增加到 66.1% （P < .001），尽管 2017 年后改善趋于平稳。所有种族和族裔群体都出现了改善，其中夏威夷原住民/太平洋岛民和黑人婴儿的改善最大（分别为 12.4% 和 9.8%）。然而，在过去 3 年中，与非西班牙裔白人 （67.6%）、黑人 （67.8%）、亚洲人 （68.9%）、夏威夷原住民/太平洋岛民 （68.5%） 和美洲印第安人/阿拉斯加原住民 （69.9%） 婴儿相比，西班牙裔婴儿无重大发病率的存活率最低 （64.3%）。黑人和西班牙裔婴儿在 snNICU 中得到不成比例的照顾，在所有时间点，无重大并发症的生存率均显著低于非 snNICU。结论 我们观察到 14 年无重大并发症的生存率有所改善，近年来进展停滞不前。解决 NICU 结果中健康不平等问题的机会仍然存在，尤其是在 snNICU 中，同时确定整体持续改进的策略。