title: Maternal race, demography, and health care disparities impact risk for intraventricular hemorrhage in preterm neonates.
abstract: OBJECTIVE
  To determine whether risk factors associated with grade 2-4 intraventricular hemorrhage (IVH) differs between infants of African ancestry and white infants.
  
  
  METHODS
  Inborn, appropriate for gestational age infants with birth weight 500-1250 g and exposure to at least 1 dose of antenatal steroids were enrolled in 24 neonatal intensive care units. Cases had grade 2-4 IVH and controls matched for site, race, and birth weight range had 2 normal ultrasounds read centrally. Multivariate logistic regression modeling identified factors associated with IVH across African ancestry and white race.
  
  
  RESULTS
  Subjects included 579 African ancestry or white race infants with grade 2-4 IVH and 532 controls. Mothers of African ancestry children were less educated, and white case mothers were more likely to have more than 1 prenatal visit and multiple gestation (P ≤ .01 for all). Increasing gestational age (P = .01), preeclampsia (P < .001), complete antenatal steroid exposure (P = .02), cesarean delivery (P < .001), and white race (P = .01) were associated with decreased risk for IVH. Chorioamnionitis (P = .01), 5-minute Apgar score <3 (P < .004), surfactant use (P < .001), and high-frequency ventilation (P < .001) were associated with increased risk for IVH. Among African ancestry infants, having more than 1 prenatal visit was associated with decreased risk (P = .02). Among white infants, multiple gestation was associated with increased risk (P < .001), and higher maternal education was associated with decreased risk (P < .05).
  
  
  CONCLUSIONS
  The risk for IVH differs between infants of African ancestry and white infants, possibly attributable to both race and health care disparities.
authors.affiliation: Department of Pediatrics, Wayne State University School of Medicine, Detroit, MI. Electronic address: sshankar@med.wayne.edu.
authors.forename: Seetha
authors.initials: S
authors.lastname: Shankaran
authors.affiliation: Department of Pediatrics, Yale University School of Medicine, New Haven, CT.
authors.forename: Aiping
authors.initials: A
authors.lastname: Lin
authors.affiliation: Department of Pediatrics, Yale University School of Medicine, New Haven, CT.
authors.forename: Jill
authors.initials: J
authors.lastname: Maller-Kesselman
authors.affiliation: Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven, CT.
authors.forename: Heping
authors.initials: H
authors.lastname: Zhang
authors.affiliation: Department of Pediatrics, Wake Forest School of Medicine, Winston Salem, NC.
authors.forename: T Michael
authors.initials: TM
authors.lastname: O'Shea
authors.affiliation: Department of Pediatrics, University of Kentucky College of Medicine, Lexington, KY.
authors.forename: Henrietta S
authors.initials: HS
authors.lastname: Bada
authors.affiliation: Departments of Pediatrics and Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX.
authors.forename: Jeffrey R
authors.initials: JR
authors.lastname: Kaiser
authors.affiliation: Department of Genetics and the Howard Hughes Medical Institute, Yale University School of Medicine, New Haven, CT.
authors.forename: Richard P
authors.initials: RP
authors.lastname: Lifton
authors.affiliation: Department of Pediatrics, University of Miami Miller School of Medicine, Miami, FL.
authors.forename: Charles R
authors.initials: CR
authors.lastname: Bauer
authors.affiliation: Department of Pediatrics, Yale University School of Medicine, New Haven, CT; Department of Neurology, Yale University School of Medicine, New Haven, CT.
authors.forename: Laura R
authors.initials: LR
authors.lastname: Ment
mesh_terms: D001741:Black or African American; D044383:Black People; D016022:Case-Control Studies; D002543:Cerebral Hemorrhage / Q000000981:diagnostic imaging / Q000208:ethnology / Q000209:etiology*; D005260:Female; D054625:Healthcare Disparities; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000000981:diagnostic imaging / Q000208:ethnology / Q000209:etiology*; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D011247:Pregnancy; D011295:Prenatal Care; D012307:Risk Factors; D012959:Socioeconomic Factors; D013548:Sweden / Q000453:epidemiology; D014463:Ultrasonography; D014481:United States / Q000453:epidemiology; D044465:White People