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Newborns of low-income parents face serious risks

Thursday October 11, 2012
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Babies born prematurely to low-income parents have a disproportionately high risk for developing brain hemorrhages that require multiple surgeries and extensive follow-up, according to findings of a small study.

The findings, based on an analysis of 38 patients referred to Johns Hopkins Children Center for treatment of brain hemorrhages related to premature birth, are a reminder of the role socioeconomic factors can play in health outcomes, the researchers said.

The link between poverty and premature birth has been well-documented, the investigators noted, but the new findings go a step further and focus on the consequences of brain hemorrhages.

"Our study shows just how detrimental and far-reaching the effects of prematurity can be, medically and otherwise, highlighting the need to better identify high-risk pregnancies and reduce the number of premature births," Edward Ahn, MD, the senior author on the research and a pediatric neurosurgeon at Hopkins Childrenís, said in a news release.

"Brain hemorrhages can have a lifelong impact on a childís neurological and cognitive development, but also create a financial burden on the families, many of whom in our study were already economically challenged."

Blood vessels in a premature brain are highly vulnerable to rapid changes in blood and brain pressure that occur around birth, according to information in the study, which is scheduled for publication in the journal Pediatric Neurosurgery. Although some brain hemorrhages are small and contained within the blood vessel, others can spread further and significantly damage the brain, particularly if not diagnosed and treated promptly. Serious hemorrhages require surgery, intensive follow-up and often long-term care to deal with the neurological and developmental after-effects of the condition.

The study tracked 38 babies treated at Hopkins Childrenís between 2007 and 2010 for complications of brain hemorrhages they had suffered during preterm birth. Most infants in the study were from low-income families (65%) and received public health insurance (63%). Household income is not part of a standard medical record, but the researchers used zip code and Medicaid status as proxies for income.

In addition to the higher risk for brain hemorrhages, the study showed babies from lower-income homes and those with public health insurance had fewer scheduled follow-up appointments and more ED visits compared with babies with private health insurance and those from higher-income homes. The researchers said the differences were clear, even though they did not reach statistical significance due to the small number of patients in the study.

"If a family forgoes a scheduled follow-up and instead ends up in the ER with a serious, yet likely preventable, complication, the medical and financial consequences can be far worse not only for the family but for the healthcare system as a whole because ER care is more expensive than routine checkups," Ahn said.

The investigators said their findings need to be replicated on a wider scale to further tease out the reasons behind the disproportionate risk.

The study abstract is available at http://content.karger.com/ProdukteDB/produkte.asp?doi=342539.


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