Redirection-Of-Care Discussions Less Likely to Happen for Black Preemies

(HealthDay News) —For infants born extremely preterm, redirection-of-care discussions occur less often for Black and Hispanic infants, according to a study published online March 11 in JAMA Pediatrics.

Jane E. Brumbaugh, M.D., from the Mayo Clinic in Rochester, Minnesota, and colleagues examined associations between maternal social determinants of health and redirection-of-care discussions in a retrospective analysis of a prospective cohort of infants born at less than 29 weeks of gestation. The infants received active treatment at birth.

The researchers found that 15 percent of the 15,629 infants from 13,643 mothers had documented redirection-of-care discussions. The percentage of infants with redirection-of-care discussions did not differ significantly by race (15 percent Black; 15 percent White) or ethnicity (14 percent Hispanic; 15 percent non-Hispanic) in unadjusted comparisons. After adjustment for maternal and neonatal factors, infants whose mothers identified as Black or Hispanic were less likely than those who identified as White or non-Hispanic to have documented redirection-of-care discussions (adjusted odds ratios, 0.84 and 0.72, respectively). There was no difference seen in redirection-of-care discussion occurrence by maternal education level or insurance type.

“Our findings suggest the possibility that race and ethnicity may be relevant to goals of care discussions and end-of-life care in the neonatal intensive care setting, and further study in this area is needed,” the authors write.

Related: Report: Pregnant Black Women Receive Highest Rate of Discrimination

What is redirection of care?

Redirection of care related to preterm birth involves the transfer of a mother and/or her preterm baby from one health care facility to another for specialized care, often due to complications arising from premature labor or delivery. Preterm birth presents significant challenges requiring specialized medical attention to ensure the best possible outcomes for both the mother and the newborn. Redirection of care in these cases aims to provide timely access to advanced medical interventions and resources that may not be available at the initial health care facility.

The decision to redirect care for preterm birth can arise from various factors, including the need for neonatal intensive care, the availability of specialized medical equipment or expertise, and the presence of complications that require higher levels of medical intervention. In many instances, redirection occurs when a pregnant woman presents with signs of preterm labor or experiences complications during pregnancy that necessitate immediate medical attention beyond the capabilities of the current health care facility redirection-of-care discussions occur less often for Black

Neonatal intensive care units (NICUs) play a critical role in the redirection of care for preterm infants. These specialized units are equipped with advanced medical technology and staffed by health care professionals trained in the care of premature and critically ill newborns. When a preterm baby requires intensive medical support, such as respiratory assistance, intravenous medications, or specialized monitoring, redirection to a NICU may be necessary to ensure the best possible outcomes for the infant.

Access to comprehensive birthing services, including maternal-fetal medicine specialists and surgical capabilities, is essential for managing high-risk pregnancies and optimizing maternal and fetal outcomes.

The process of redirection of care for preterm birth requires coordination and collaboration among health care providers, including obstetricians, neonatologists, nurses, and transport teams. Timely communication and transfer of medical information, including prenatal records, maternal history, and fetal monitoring data, are essential to ensure continuity of care and minimize delays in accessing necessary medical interventions. In addition to medical considerations, redirection of care for preterm birth may also involve logistical and psychosocial factors.

Health care professionals involved in the redirection of care for preterm birth must adhere to established guidelines and protocols to ensure the safety and well-being of the mother and baby throughout the transfer process. This includes assessing the stability of the mother and/or newborn, ensuring appropriate medical stabilization before transfer, and monitoring vital signs and clinical status during transport.

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