465 - Risk Factors for Prematurity in Infants Admitted to a Texas Quaternary-Level Neonatal Intensive Care Unit

Poster Number: 465
Publication Number: 465.130

Manvitha V. Katta, Baylor College of Medicine, Manvel, TX, United States; Amaryllis Fernandes, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX, United States; Anne Debuyserie, Baylor College of Medicine, Houston, TX, United States; Joseph Hagan, Baylor College of Medicine, Houston, TX, United States; Caraciolo J. Fernandes, Baylor College of Medicine, Houston, TX, United States; Charleta Guillory, Baylor College of Medicine, Houston, TX, United States

Background: Prematurity, the primary cause of death for babies born in the United States, is associated with substantial long-term health problems. Black infants are disproportionately affected by prematurity, and this inequality persists across different socio-economic strata and geographic areas. Social Determinants of Health (SDOH) influence health disparities.  As the largest Level IV Neonatal Intensive Care Unit in Texas, Texas Children’s Hospital (TCH) takes care of the most critically-ill newborns in the greater Houston area. However, risk factors and demographic trends associated with prematurity within a Level IV NICU have not yet been characterized.

Objective: The objective of this study was to characterize and understand the risk factors for prematurity present at birth among a cohort of infants admitted to a quaternary Neonatal Intensive Care Unit at Texas Children’s Hospital in Houston, Texas.

Design/Methods: In this cohort study, the Children’s Hospital Neonatal Consortium dataset was queried for maternal and infant characteristics of infants born between 28-37 weeks of gestation who were admitted to the TCH NICU between January 2014 to December 2018. The chi-square test was used to investigate associations with prematurity.  Stratified analyses were done to examine these associations separately for inborn and outborn patients.

Results: 5156 infants met the study inclusion criteria, with 2197 born at TCH and 2959 born elsewhere in Houston. Of all admitted infants, 41% were born preterm. Maternal race, assisted reproductive technology, antenatal steroids, maternal diabetes, maternal hypertension, multiplicity of births and insurance type were all significantly associated with preterm birth, across both inborn and outborn cohorts (all p-values < 0.05). Hispanic origin, prenatal care, congenital anomalies diagnosed prenatally and chorioamnionitis were not significantly associated with preterm birth (p >0.05). See Table 1.Conclusion(s): Among the most critically-ill children in Houston admitted to a Level IV NICU, there are several risk factors associated with prematurity. White maternal race and private insurance are protective factors. Specific maternal morbidities, including diabetes and hypertension, increase the risk of preterm birth. Although having prenatal care was not found to be significant, better antenatal care is important to control the complications of these conditions. Increasing access to prenatal care, especially in underserved Houston neighborhoods with high populations of Black women on public insurance has tremendous potential to decrease rates of prematurity and its complications.
Manvitha Katta Resume (2).pdf
Figure 1Term and Preterm Births by Maternal Race