RESUMO
Racism, segregation, and inequality contribute to health outcomes and drive health disparities across the life course, including for newborn infants and their families. In this review, we address their effects on the health and well-being of newborn infants and their families with a focus on preterm birth. We discuss three causal pathways: increased risk; lower-quality care; and socioeconomic disadvantages that persist into infancy, childhood, and beyond. For each pathway, we propose specific interventions and research priorities that may remedy the adverse effects of racism, segregation, and inequality. Infants and their families will not realize the full benefit of advances in perinatal and neonatal care until we, collectively, accept our responsibility for addressing the range of determinants that shape long-term outcomes.
Assuntos
Saúde da Família/etnologia , Disparidades nos Níveis de Saúde , Disparidades em Assistência à Saúde/etnologia , Criança Pós-Termo/crescimento & desenvolvimento , Nascimento Prematuro/etnologia , Nascimento Prematuro/prevenção & controle , Racismo/etnologia , Determinantes Sociais da Saúde , Segregação Social , Criança , Desenvolvimento Infantil , Pré-Escolar , Feminino , Acessibilidade aos Serviços de Saúde , Humanos , Lactente , Recém-Nascido , Gravidez , Fatores Raciais , Medição de Risco , Fatores de Risco , Estados Unidos/epidemiologiaRESUMO
The medical records of 403 infants admitted to the neonatal intensive care unit were reviewed. All were postterm (greater than or equal to 42 weeks' gestation) infants or infants who were full term (greater than or equal to 38 weeks' gestation) and had clinical diagnoses associated with the neonatal postmaturity/dysmaturity syndrome. Data collected from these 403 records were used to generate frequency distribution tables for a variety of obstetric and neonatal outcome variables. Regression analyses were used to assess associations among these variables and the presence or absence of fetal malnutrition (dysmaturity) or postdatism. Fetal distress and neonatal acidosis were associated with both dysmaturity and postdatism. Primigravidas, meconium-stained amniotic fluid, cesarean section, birth trauma, and neonatal death were associated with postdatism but not with dysmaturity. Preeclampsia, maternal smoking, oligohydramnios, low Apgar score, neonatal pulmonary hypertension, neurologic abnormalities, and a need for extracorporeal membrane oxygenation were associated with dysmaturity. No interaction between postdatism and dysmaturity was seen for any outcome variable. Postdatism and dysmaturity appear to contribute risk factors independently to infants admitted to the intensive care unit.
