Treatment and mortality of aboriginal and Caucasian babies in 17 Canadian neonatal care units

Purpose In Canada, population-based studies report higher perinatal morbidity and mortality among Aboriginal infants than among Caucasians. The aim of this study was to compare baseline characteristics, treatment intensity, and mortality of Aboriginal versus Caucasian babies in neonatal intensive care units (NICU). Methods We examined 12,564 infants with information on ethnicity from 17 tertiary care NICUs across Canada from January 1996 to October 1997. Patient information included demographic variables, health status of infant and problems at birth, and standardized measures on illness severity (Score for Neonatal Acute Physiology Version II), and therapeutic intensity (Neonatal Therapeutic Intensity Scoring System, or NTISS). Patients were tracked until death or discharge home. Bivariate analyses and multiple linear regression analyses were conducted. Multiple births and babies with other ethnicities than Aboriginal and Caucasian were excluded. Results Aboriginal (n = 709) and Caucasian (n = 8333) babies did not differ in terms of Apgar score, gestational age, and intrauterine growth restriction. The mean birth weight (g) was higher among Aboriginals (2674, SD = 1.08) than among Caucasians (2535, SD = 1.04). The mean severity of illness score was higher among Caucasians (7.6, SD = 10.8 vs. 6.7, SD = 11.7). The mean treatment intensity score was higher for Caucasian infants (12.4, SD = 7.5 vs. 11.5, SD = 8.7). After adjustment for birth weight and illness severity, there were no ethnic differences in treatment score. There were no differences in mortality rate (odds ratio = 0.99, 95% confidence interval = 0.90–1.09). Conclusion Contrary to population-based samples, in this highly selected sample there were no ethnic differences in infant mortality. Treatment intensity did not differ between Aboriginal and Caucasian babies, if adjusted for confounders. Further studies should examine whether increased access to tertiary care may help to reduce infant mortality rates in the Aboriginal population.