Courtney Townsel

Objective The objective of this study was to assess whether in-hospital morbidity or mortality differed by race/ethnicity for preterm neonates admitted to the neonatal intensive care unit (NICU). Study Design In a retrospective cohort study, preterm infants, < 37 weeks, were admitted to the NICU from 1994 to 2009. Exclusions included structural anomalies and aneuploidy. Primary outcome was in-hospital mortality (IHM). Secondary outcomes were respiratory distress syndrome (RDS), interventricular hemorrhage (IVH), necrotizing enterocolitis (NEC), and retinopathy of prematurity (ROP). Sub-analysis of very preterm (VPT) infants, < 28 weeks, was performed. Five racial/ethnic groups (REGs) were compared: White, Black, Hispanic, Asian, and Mixed. Associations were modeled by logistic regression. White neonates (WNs) were the referent group. Unadjusted and adjusted odds ratios and 95% confidence intervals for remaining REGs were reported. p value was significant at 5% for overall tests and at Bonferroni-corrected level < 0.0125 for between-race comparisons with WNs. Results Four thousand nine hundred fifty-five preterm neonates were identified; 153 were excluded leaving 4802 for analysis. After controlling covariates that were chosen a priori, there was no difference across REGs for IHM (all between-race comparison p values > 0.0125). There was a significant difference in RDS among Black neonates (BNs) (aOR 0.57, 95% CI 0.45–0.73; p < 0.001) and Hispanic neonates (HNs) (aOR 0.67, 95% CI 0.50–0.89; p = 0.005) compared to WNs. The risk of ROP was significantly different across REGs with HNs having a 70% increase in ROP (aOR 1.70, 95% CI 1.15–2.49; p = 0.008) and Mixed neonates (MNs) experiencing a 55% reduction (aOR 0.45, 95% CI 0.29–0.68; p < 0.001) compared to WNs. There was no difference in IVH or NEC across REGs (all p values > 0.0125). In the VPT cohort sub-analysis, BNs experienced a significant 59% reduction in IHM compared to WNs (BNs aOR 0.41, 95% CI 0.22–0.73; p = 0.003). MNs experienced a 46% reduction in ROP compared to WNs (aOR 0.54, 95% CI 0.35–0.81; p = 0.004). There was no difference in RDS, IVH, or NEC in very preterm infants across REGs (all between comparison p values > 0.0125). Conclusion In preterm neonates, in-hospital mortality does not significantly differ across racial and ethnic groups. However, in very preterm infants, in-hospital mortality for Black neonates is improved. There are morbidity differences (RDS, ROP) seen among racial/ethnic groups.

Excisional cervical procedures and genital infections are independent risks for preterm birth (PTB). We evaluated if LEEP history and cervical Mycoplasma/Ureaplasma (Myco/Urea) co-infection increases risk of PTB. Retrospective cohort study (1/2005 to 6/2016) of patients delivered under 37 weeks. Patients were selected by Myco/Urea admission cervical culture results. Medical record abstractions: demographics, cervical procedures history, pregnancy outcome. Exclusions: cerclage, knife cone, cryotherapy, multifetal gestations. CASES: LEEP history and positive Myco/Urea result, CONTROL GROUP A: LEEP history and negative Myco/Urea result, CONTROL GROUP B: without LEEP history and positive Myco/Urea result. Primary outcome: delivery gestational weeks (GW). Data analyzed by Fisher's exact, chi-square and Wilcoxon rank-sum tests. A linear regression model for comparison of CASES vs CONTROLS was adjusted for potential confounders. A p-value less than 0.05 (two-tailed) was significant. We identified 1755 patients with Myco/Urea results: 37 CASES, 17 GROUP A , 47 GROUP B. Delivery GW: Cases 32±3.8, Control A 30.6 ±4.4, Control B 31.6±3.3 (p more than 0.05 Cases vs Controls). No significant difference in percentage of PPROM, smoking, antibiotic use between Cases vs Controls (p more than 0.05). A history of PTB was greater in Cases (32%) vs Control A (18%, p=0.34) or Control B (13%, p= 0.04). However, cases delivered earlier than controls. Antibiotic use was not different in CASES (51%) vs CONTROL B (48%); p=0.95. LEEP history and co-infection with genital Myco/Urea is not associated with increased risk for PTB compared to patients with LEEP history alone or Myco/Urea infection alone.

Racial disparities exist in pregnancy outcomes and infant mortality. We explored whether in-hospital morbidity or mortality differed by race for preterm neonates admitted to a single academic institution's NICU. Retrospective cohort analysis of preterm infants, under 37 weeks, within NIS-3 database from 1994-2009. Anomalies and aneuploidy were excluded. Primary outcome was death before discharge. Secondary outcomes were respiratory distress syndrome (RDS), interventricular hemorrhage (IVH), and necrotizing enterocolitis (NEC). Planned sub-analysis of very preterm (VPT) infants, under 28 weeks, was performed. Four racial groups were compared with odds ratio compared to Caucasian neonates (CN). Logistic regression was performed with P-value less than 0.05 significant. 4,802 neonates were included. There was no difference across racial groups (RGs) in death before discharge (p=0.106). Mixed neonates had a 60% increased risk of in-hospital death (IHD) compared to CNs [OR 1.60 (1.05-2.40), p=0.026]. There was a significant reduction in RDS for all three RGs compared to CNs (p=0.004). There was no difference between RGs for IVH (p=0.280) or NEC (p=0.099). In the VPT cohort IHD, RDS and NEC did not differ across RGs (p=0.151, p=0.538, p=0.905, respectively). There was a significant increase in IVH across VPT RGs (p=0.038). Asian neonates accounted for majority of IVH morbidity compared to CNs [OR 3.21 (1.09-9.07), p=0.029]. IHD does not differ across RGs in preterm neonates admitted to the NICU. CNs have a higher rate of RDS than other RGs.

For the past century researchers have underscored the “disadvantage” observed in respiratory morbidity and mortality of male newborns. In this contemporary review we examine gender differences in preterm infant respiratory morbidity and mortality specifically appraising differences in the very low birth weight (VLBW) population as well as the late preterm (LPT) population. In the era of postnatal surfactant and antenatal corticosteroids the gender gap in neonatal outcomes has not narrowed. Structural, physiologic, and hormonal sex differences may be at the root of this disparity. Further exploration into the origin of gender differences in respiratory morbidity and neonatal mortality will shape future therapies. These therapies may need to be gender specific to close the gender gap.

Background Myasthenia gravis (MG) is an autoimmune disorder with fluctuating muscle weakness, divided into generalized and localized (ocular) forms. Maternal antibodies to acetylcholine receptors cross the placenta and may cause transient neonatal myasthenia gravis (TNMG). We present a case of seronegative maternal ocular MG and delayed TNMG. Case A 29-year-old G3P1011 underwent cesarean birth of a male infant who developed oxygen desaturation requiring supplemental oxygen on day of life (DOL) 3. Based on the clinical course and after exclusion of other diagnoses, the infant was diagnosed with TNMG. Infant's condition improved spontaneously and he was weaned off supplemental oxygen and discharged home on DOL 12. Conclusion Infants born to mothers with seronegative localized (ocular) MG are also susceptible to TNMG which may be late in onset.