Racial Disparities in Breastmilk Receipt and Extremely Low Gestational Age Neonatal Morbidities in an Asian Pacific Islander Population

Background:

Background: Racial minorities including Black infants experience lower rates of exclusive breastmilk feedings and experience higher rates of adverse outcomes of prematurity, such as intraventricular hemorrhage (IVH), necrotizing enterocolitis (NEC), and death. However, there is limited information known on outcomes among Asian and Pacific Islander infants. Native Hawaiians (NH), other Pacific Islanders (PI), and Filipinos are known to have disproportionately higher morbidities including preterm birth, low infant birthweight, obesity, poor prenatal care, drug use, and diabetes. This objectives of this study are to evaluate a neonatal intensive care unit (NICU) in a predominately Asian and Pacific Islander population in Honolulu, Hawai‘i for: 1.) Racial differences in the receipt of breastmilk within 24 hours of admission and at discharge. 2.) Racial differences in mortality, NEC and IVH among infants ≤28 weeks gestational age

Methods: We performed a retrospective chart review of 2531 infants born from 2018 to 2020 in the largest level 3 NICU in Honolulu, Hawaii, excluding infants who were transferred from outside hospitals, underwent surgery during the first week of life for congenital abnormalities, or transported to another hospital for higher level of care. Logistic regression analysis was performed on the study outcomes to calculate odds ratios while controlling for gestational age, birthweight, mode of delivery, twin/triplet delivery, maternal drug use, maternal receipt of antenatal steroids, and insurance type.

Results: Preliminary analyses show receipt of breastmilk within the first 24 hour of admission were lower among Filipinos compared to Asians (OR: 0.63, 95% CI [0.47, 0.85]) and lower among Asians compared to Whites (OR: 0.55 95% CI [0.39, 0.78]). Receipt of breastmilk at discharge were lower among Filipinos (OR: 0.67, 95% CI [0.50, 0.91]), PIs (OR: 0.57, 95% CI [0.41, 0.79]), and NHs (OR: 0.72, 95% CI [0.54, 0.97]) compared to Asians. PIs were more likely than Asians to have any IVH (OR: 3.80, 95% CI [1.12, 12.95]) and NEC (OR: 9.57, 95% CI [1.36, 67.51]). No significant differences were found in rates of mortality and severe IVH among racial groups.

Conclusion: NHs, PIs, and Filipinos were less likely to receive breastmilk at discharge compared to Asians. Furthermore, PIs were more likely to experience any IVH and NEC compared to Asians. Additional analysis is underway to examine possible disparities in chronic lung disease (CLD), severe retinopathy of prematurity (ROP), periventricular leukomalacia (PVL), as well as a composite outcome of mortality, severe IVH, severe ROP, CLD or PVL. This study underlines the importance of disaggregating Asian and Pacific Islander groups to understand underlying differences in health outcomes. Further research is needed to understand these neonatal disparities and to promote the development of culturally-targeted education, screening programs, or quality improvement initiatives to address underlying risk factors for inequities.