370 - Demographic and Socioeconomic Disparities in Length of Hospitalization of Late Preterm Infants with Respiratory Distress

Publication Number: 370.4414

Toni Iurcotta, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States; Sinead F. Brady, Columbia University Medical Center, New York, NY, United States; Rakesh Sahni, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States

Background: Late preterm (LPT) infants, representing three-fourths of all preterm births, experience morbidities seven times more frequently than term infants. Many LPT infants develop respiratory distress (RD) requiring respiratory support that may impact their length of hospitalization (LOH). It remains unknown whether the LOH in LPT infants with RD is influenced by inequities in health care.

Objective: To assess for differences in LOH among LPT infants with RD based on the sociodemographic factors of sex, race, ethnicity, and medical insurance coverage type.

Design/Methods: We conducted a retrospective cohort study of the LOH for all inborn LPT infants (34 0/7- 36 6/7 weeks gestational age) admitted to the Columbia University Irving Medical Center/NewYork Presbyterian Morgan Stanley Children’s Hospital NICU in 2022 and 2023. We assessed the need for respiratory support and evaluated the differences in LOH across the sociodemographic domains of sex, race, ethnicity, and medical insurance coverage type between LPT infants that required RS (CPAP group) or those that did not (No RS group) using unpaired t-tests.

Results: Data were available for 586 patients (GA = 34.6±0.8 weeks, birth weight = 2313±513 g). Of this cohort, 45.2% did not require RS while 54.8% did (continuous positive airway pressure (CPAP) 42.6%, mechanical ventilation (MV) 3.6%, some combination of CPAP and MV 8.6%; table 1). Surfactant was administered to few infants (2.5%), all via endotracheal tube. LOH was longer for the CPAP group compared with the No RS group (20.7 vs 14.4 days, p< 0.001).
The data revealed inequalities in the LOH of LPT infants in three sociodemographic domains when CPAP requirement was taken into account as shown in figure 1: with respect to race (No RS group: Black vs White, 10.9 vs 14.5 days, p< 0.05), ethnicity (CPAP group: Hispanic vs non-Hispanic, 23.5 vs 15.3 days, p< 0.05), and insurance type (Medicaid vs private insurance, 14.0 vs 12.1 days, p< 0.05). There were no significant differences in LOH based on sex (CPAP group: male vs female, 23.6 vs 18.4, p=0.08, and No RS group: male vs female, 14.9 vs 13.9, p=0.3).

Conclusion(s): LPT infants with RD have longer LOH compared with those without RD. The LOH in LPT infants varies with race, ethnicity, and medical insurance type. These findings underscore that potential inequalities in health equity may exist for infants of color and those who may be born to economically disadvantaged families. More research is needed to identify the practice gaps that contributed to the current findings and to determine if disparities exist in other health equity domains and clinical outcomes.

Table 1. Need for respiratory support after birth in late preterm infants and length of hospitalization
RD, respiratory distress; LOH, length of hospitalization; CPAP, continuous positive airway pressure; MV, mechanical ventilation

Figure 1. Length of hospitalization in late preterm infants based on sociodemographic domain and CPAP requirement
RS, respiratory support; CPAP, continuous positive airway pressure.
*No RS vs. CPAP requirement data was not available for the comparison of medical insurance coverage type.