320 - Racial Inequities in Therapeutic Hypothermia and Adverse Outcomes of Hypoxic Ischemic Encephalopathy

Poster Number: 320
Publication Number: 320.1412

Background: Previous studies have demonstrated racial inequities in the neonatal intensive care unit in the United States, particularly regarding infants of Black mothers. However, racial inequities in the treatment of neonatal hypoxic ischemic encephalopathy have not previously been reported.

Objective: The objective of this study is to investigate racial inequities in the use of therapeutic hypothermia (TH) and outcomes in infants with hypoxic ischemic encephalopathy (HIE).

Design/Methods: We queried an administrative birth cohort of mother-baby pairs in California from 2010-2019 using ICD codes to evaluate the association between race/ethnicity and therapeutic hypothermia and adverse outcomes in infants with HIE. We identified 4,779 infants with gestation >35 weeks with HIE. Log-linear regression was used to calculate risk ratios (RR) for TH, adjusting for hospital transfer, rural location, late preterm birth, and HIE severity. Risk of adverse infant outcome was calculated by race/ethnicity adjusting for sepsis, HIE severity, and seizures, and stratifying by TH.

Results: In this cohort, 1338 (28.0%) neonates with HIE were treated with TH. The reference population was White infants and 410 (28.4%) were treated with TH. Black infants were significantly less likely to receive TH with 74 (20.0%) undergoing TH with an adjusted risk ratio (aRR) of 0.7 (95% confidence interval 0.5 to 0.9). Hispanic infants were also less likely to undergo TH, but this did not reach statistical significance (aRR 0.93, 95% CI 0.82 to 1.06). Black infants with any HIE who did not receive TH were more likely to have a hospital readmission (aRR 1.36, 95% CI 1.10 to 1.68) and a tracheostomy (aRR 3.07, 95% CI 1.19 to 7.97). Black infants with moderate/severe HIE who did not receive TH were more likely to be diagnosed with cerebral palsy (aRR 2.72, 95% CI 1.07 to 6.91).

Conclusion(s): Therapeutic hypothermia is currently the only standard treatment shown to improve outcomes for neonatal HIE. In this study we found that Black infants with HIE were significantly less likely to receive therapeutic hypothermia treatment even after adjusting for factors that may impact the decision to offer therapeutic hypothermia. Black infants were also found to have significantly increased risk of some adverse outcomes of HIE. Possible reasons for these disparities include systemic barriers to care and systemic bias/racism. This study is limited by the use of ICD 9/10 codes and a one year follow up time. Further evaluation of outcomes of Black infants with HIE should be performed.