Event Title
Location
Philadelphia, PA
Start Date
3-5-2023 1:00 PM
End Date
3-5-2023 4:00 PM
Description
Introduction: Given the risk of early-onset sepsis, providers frequently prescribe empirical antibiotics to newborns admitted to the neonatal intensive care unit (NICU). Early and prolonged use of antibiotics in uninfected newborns is associated with many adverse effects and potentially life-threatening complications, particularly among those with very low birth weight (VLBW; <1500g). Studies of neonatal antibiotic utilization often adjust for race, acknowledged as a social construct, but there is a paucity of data on whether there is an independent association between race and antibiotic use in this population. We hypothesized that Black newborns have higher antibiotic use after adjusting for confounding factors compared to other races.
Design/Methods: Retrospective cohort study including newborns admitted to a NICU from 2012-2021 included in the Premier Health database, which captures inpatient encounters from academic and community hospitals across the US. Early antibiotic initiation was defined as any parenteral antibiotic administered within the first 3 days after birth. Prolonged antibiotic duration was defined as early antibiotic initiation that was continued for >4 days. Race was categorized as non-Hispanic Black, non-Hispanic White, non-Hispanic Asian, Hispanic, and Other/unknown race or ethnicity. Standard descriptive and comparative statistics were performed. Multivariable logistic regression, stratified by birth weight ≥ and <1500g, was used to determine the association between race (non-Hispanic Black vs non-Hispanic White, and non-Hispanic Black vs other races/ethnicities) and early/prolonged antibiotic use, adjusting for potential confounders including birthweight category, length of stay, hospital setting, geographic region, and teaching status, accounting for clustering by center.
Results: A total of 865,893 newborns from 699 NICUs were included. Overall, 478,045 (55.2%) were male, 108,896 (12.6%) were Hispanic ethnicity, 5236 (0.6%) died, and median length of stay was 7 days (IQR 4,17). Demographics and clinical characteristics between the different race/ethnicity groups are shown in Table 1. In the unadjusted analysis comparing infants of non-Hispanic Black race to non-Hispanic White and other race/ethnicity, stratified by birth weight ≥ and <1500g, there were differences in antibiotic initiation and prolonged duration identified (Table 2). After adjusting for available potential confounders and accounting for clustering by center, non-Hispanic Black infants ≥ 1500g had higher odds of antibiotic initiation (aOR 1.09, 95%CI 1.02,1.2; p=0.02) compared to non-Hispanic White infants (Table 2). Non-Hispanic Black infants <1500g had higher odds of antibiotic initiation (aOR 1.4, 95%CI 1.3,1.6; p<0.001) and prolonged antibiotic duration (aOR 1.2, 95%CI 1.02,1.4; p=0.03) compared to non-Hispanic White infants, and higher odds of antibiotic initiation (aOR 1.3, 95%CI 1.1,1.5; p<0.001) compared to other races/ethnicities (Table 2).
Discussion: Newborns of non-Hispanic Black race/ethnicity compared to non-Hispanic White had increased odds of antibiotic initiation when stratified by birth weight. Non-Hispanic black infants with birth weight <1500g also had increased odds of antibiotic initiation when compared to other races/ethnicities. Though this study is limited due to low granularity of patient level data and associations possibly being confounded by other factors, its significance still warrants further study. Future studies must explore if other factors, including maternal factors influenced by structural racism, are being considered when prescribing early antibiotics in the NICU.
Embargo Period
7-5-2023
Included in
Association Between Race and Early Antibiotic Use in Newborns Admitted to the Neonatal Intensive Care Unit
Philadelphia, PA
Introduction: Given the risk of early-onset sepsis, providers frequently prescribe empirical antibiotics to newborns admitted to the neonatal intensive care unit (NICU). Early and prolonged use of antibiotics in uninfected newborns is associated with many adverse effects and potentially life-threatening complications, particularly among those with very low birth weight (VLBW; <1500g). Studies of neonatal antibiotic utilization often adjust for race, acknowledged as a social construct, but there is a paucity of data on whether there is an independent association between race and antibiotic use in this population. We hypothesized that Black newborns have higher antibiotic use after adjusting for confounding factors compared to other races.
Design/Methods: Retrospective cohort study including newborns admitted to a NICU from 2012-2021 included in the Premier Health database, which captures inpatient encounters from academic and community hospitals across the US. Early antibiotic initiation was defined as any parenteral antibiotic administered within the first 3 days after birth. Prolonged antibiotic duration was defined as early antibiotic initiation that was continued for >4 days. Race was categorized as non-Hispanic Black, non-Hispanic White, non-Hispanic Asian, Hispanic, and Other/unknown race or ethnicity. Standard descriptive and comparative statistics were performed. Multivariable logistic regression, stratified by birth weight ≥ and <1500g, was used to determine the association between race (non-Hispanic Black vs non-Hispanic White, and non-Hispanic Black vs other races/ethnicities) and early/prolonged antibiotic use, adjusting for potential confounders including birthweight category, length of stay, hospital setting, geographic region, and teaching status, accounting for clustering by center.
Results: A total of 865,893 newborns from 699 NICUs were included. Overall, 478,045 (55.2%) were male, 108,896 (12.6%) were Hispanic ethnicity, 5236 (0.6%) died, and median length of stay was 7 days (IQR 4,17). Demographics and clinical characteristics between the different race/ethnicity groups are shown in Table 1. In the unadjusted analysis comparing infants of non-Hispanic Black race to non-Hispanic White and other race/ethnicity, stratified by birth weight ≥ and <1500g, there were differences in antibiotic initiation and prolonged duration identified (Table 2). After adjusting for available potential confounders and accounting for clustering by center, non-Hispanic Black infants ≥ 1500g had higher odds of antibiotic initiation (aOR 1.09, 95%CI 1.02,1.2; p=0.02) compared to non-Hispanic White infants (Table 2). Non-Hispanic Black infants <1500g had higher odds of antibiotic initiation (aOR 1.4, 95%CI 1.3,1.6; p<0.001) and prolonged antibiotic duration (aOR 1.2, 95%CI 1.02,1.4; p=0.03) compared to non-Hispanic White infants, and higher odds of antibiotic initiation (aOR 1.3, 95%CI 1.1,1.5; p<0.001) compared to other races/ethnicities (Table 2).
Discussion: Newborns of non-Hispanic Black race/ethnicity compared to non-Hispanic White had increased odds of antibiotic initiation when stratified by birth weight. Non-Hispanic black infants with birth weight <1500g also had increased odds of antibiotic initiation when compared to other races>/ethnicities. Though this study is limited due to low granularity of patient level data and associations possibly being confounded by other factors, its significance still warrants further study. Future studies must explore if other factors, including maternal factors influenced by structural racism, are being considered when prescribing early antibiotics in the NICU.