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Racial disparities and outcomes in neonatal hypoxic-ischemic encephalopathy

Journal of Perinatology (2025)Cite this article

Subjects

Abstract

Objectives

To investigate racial disparities in the prevalence, severity, intervention, and outcomes of hypoxic-ischemic encephalopathy (HIE) among neonates in the United States.

Study design

We analyzed data from the National Inpatient Sample (NIS) dataset, including full-term infants diagnosed with HIE from 2010 to 2018. Regression analysis was performed to control for clinical and demographic variables.

Results

Out of 31,249,100 infants, 23,475 (0.09%) were diagnosed with HIE. African American neonates had a 60% higher likelihood of developing HIE compared to Caucasians, adjusted odds ratio (aOR) 1.60 (1.52–1.69, p < 0.001), and were twice as likely to experience severe HIE, aOR 2.06 (1.77–2.39, p < 0.001). Overall mortality was significantly higher among African American infants, aOR 2.14, (2.02–2.26, p < 0.001). Mortality within HIE infants did not differ between African American and Caucasian infants aOR 0.88 (0.78–1.0), p < 0.61. Native American infants had a significantly lower chance of receiving hypothermia therapy compared to Caucasian infants, aOR 0.48 (0.29–0.77), p = 0.002.

Conclusion

Racial disparity exists in the prevalence, severity, and management of HIE. African Americans experience a higher prevalence and severity of HIE. Native Americans are less likely to receive hypothermia therapy for HIE.

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Data availability

All data generated or analyzed during this study are included in this published article.

References

  1. Shipley L, Gale C, Sharkey D. Trends in the incidence and management of hypoxic-ischemic encephalopathy in the therapeutic hypothermia era: a national population study. Arch Dis Child Fetal Neonatal Ed. 2021;106:529–34.

    Article  PubMed  Google Scholar 

  2. Ambalavanan N, Shankaran S, Laptook AR, Carper BA, Das A, Carlo WA, et al. Early determination of prognosis in neonatal moderate or severe hypoxic-ischemic encephalopathy. Pediatrics. 2021;147:e2020048678.

    Article  PubMed  Google Scholar 

  3. El-Dib M, Inder TE, Chalak LF, Massaro AN, Thoresen M, Gunn AJ. Should therapeutic hypothermia be offered to babies with mild neonatal encephalopathy in the first 6 h after birth? Pediatr Res. 2019;85:442–8.

    Article  PubMed  Google Scholar 

  4. Chalak LF, Nguyen KA, Prempunpong C, Heyne R, Thayyil S, Shankaran S, et al. Prospective research in infants with mild encephalopathy identified in the first six hours of life: neurodevelopmental outcomes at 18-22 months. Pediatr Res. 2018;84:861–8.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Finder M, Boylan GB, Twomey D, Ahearne C, Murray DM, Hallberg B. Two-Year Neurodevelopmental Outcomes After Mild Hypoxic Ischemic Encephalopathy in the Era of Therapeutic Hypothermia. JAMA Pediatr. 2020;174:48–55.

    Article  PubMed  Google Scholar 

  6. Bradfield WD, Cox S, Handerson Z. Disparities in neonatal intensive care: Context matters. Pediatrics. 2019;144:e20191688.

    Article  Google Scholar 

  7. Boghossian NS, Geraci M, Edwards EM, et al. Changes in hospital quality at hospitals serving black and Hispanic newborns below 30 weeks gestation. J Perinatol. 2022;42:187–94.

    Article  PubMed  Google Scholar 

  8. Giurgescu C, Banks A, Dancy BL, Norr K. African American women’s views of factors impacting preterm birth. MCN Am J Matern Child Nurs. 2013;38:229–34.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Boghossian NS, Geraci M, Lorch SA, Phibbs CS, Edwards EM, Horbar JD. Racial and ethnic differences over time in outcomes of infants born less than 30 weeks gestation. Pediatr. 2019;144:e20191106.

    Article  Google Scholar 

  10. HCUP: hcup-us.ahqr.gov/kidoverview.jsp#structure accessed on 01/31/2024

  11. Silveira RC, Procianoy RS. Hypothermia therapy for newborns with hypoxic-ischemic encephalopathy. J Pediatr. 2015;91:78–83.

    Article  Google Scholar 

  12. Parker SJ, Kuzniewicz M, Niki H, Wu YW. Antenatal and intrapartum risk factors for hypoxic-ischemic encephalopathy in a US Birth Cohort. J Pediatr. 2018;203:163–9.

    Article  PubMed  Google Scholar 

  13. Janevic T, Zeitlin J, Auger N, Egorova NN, Hebert P, Balbierz A, et al. Association of race/ethnicity with very preterm neonatal morbidities. JAMA Pediatr. 2018;172:1061–9.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Willis E, McManus P, Magallanes N, Johnson S, Majnik A. Conquering racial disparities in perinatal outcomes. Clin Perinatol. 2014;41:847–75.

    Article  PubMed  Google Scholar 

  15. Wallace M, Crear-Perry J, Richardson L, Tarver M, Theall K. Separate and unequal: structural racism and infant mortality in the US. Health Place. 2017;45:140–4.

    Article  PubMed  Google Scholar 

  16. Macdorman MF, Mathews TJ. Understanding racial and ethnic disparities in the US. Infant mortality rates. NCHS Data Brief. 2011;74:1–8.

    Google Scholar 

  17. Sutton MY, Anachebe NF, Lee R, Skanes H. Racial and ethnic disparities in reproductive health services and outcomes. Obstet Gynecol. 2021;137:225–33.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Wang Y, Xu Y, Zhou C, Cheng Y, Qiao N, Shang Q, et al. Exome sequencing reveals genetic heterogeneity and clinically actionable findings in children with cerebral palsy. Nat Med. 2024;30:1395–405.

    Article  PubMed  CAS  Google Scholar 

  19. Morell AS, Monsell SE, Cornet MC, Wisnowski JL, McKinstry RC, Mathur AM, et al. Genetic and congenital anomalies in infants with hypoxic-ischemic encephalopathy. Pediatr Neurol. 2024;154:44–50.

    Article  PubMed  Google Scholar 

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Author information

Author notes

  1. These authors contributed equally: Hany Aly, Mohamed A. Mohamed.

Authors and Affiliations

  1. Department of Pediatrics & Neonatology, University of Florida College of Medicine-Jacksonville, Jacksonville, FL, USA

    Marwa M. Elgendy

  2. Department of Neonatology, Cleveland Clinic Children’s, Cleveland, OH, USA

    Ceyda Acun, Hany Aly & Mohamed A. Mohamed

  3. Department of Neonatology, University of Florida College of Medicine-Jacksonville, Jacksonville, FL, USA

    Josef Cortez

Authors
  1. Marwa M. Elgendy
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  2. Ceyda Acun
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  3. Josef Cortez
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  4. Hany Aly
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  5. Mohamed A. Mohamed
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Contributions

Drs. Elgendy, Cortez, and Acun conceptualized and designed the study, interpreted the statistical analyses, drafted the initial manuscript, reviewed and revised the manuscript and critically reviewed the manuscript for important intellectual content. Dr. Aly conceptualized and designed the study, interpreted the statistical analyses, reviewed and revised the manuscript, and critically reviewed the manuscript for important intellectual content. Dr. Mohamed conceptualized and designed the study, conducted the statistical analyses, edited and revised the initial manuscript, reviewed and revised the manuscript and critically reviewed the manuscript for important intellectual content. All authors approved the final manuscript as submitted and agreed to be accountable for all aspects of the work.

Corresponding author

Correspondence to Marwa M. Elgendy.

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Elgendy, M.M., Acun, C., Cortez, J. et al. Racial disparities and outcomes in neonatal hypoxic-ischemic encephalopathy. J Perinatol (2025). https://doi.org/10.1038/s41372-025-02335-9

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  • DOI: https://doi.org/10.1038/s41372-025-02335-9

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