Respiratory morbidity and mortality in Black and White preterm infants

Abstract Objectives To evaluate the association between parental ethnicity and respiratory outcomes in infants born before 34 weeks of gestation. Methods Retrospective matched case-comparison study of inborn infants admitted to two London tertiary neonatal units between September 2022 and September 2025. Infants were included if both parents self-identified as Black (African or Caribbean) or White (British, Irish or Other) ethnicity. Clinical data were collected from electronic records. The primary outcome was the rate of bronchopulmonary dysplasia (BPD). Results 394 infants (197 Black, 197 White) were matched by gestational age (GA). The Black cohort had higher rates of gestational diabetes (GDM) (20.5 vs. 7.6 %, p<0.001) and of being small for gestational age (SGA) (32.0 vs. 19.3 %, p=0.004). After adjustment for GA, GDM and SGA, infants of Black ethnicity had significantly lower odds of requiring mechanical ventilation (p=0.029) and of the composite outcome of BPD or death (p=0.04). When the Black cohort was divided into African (n=157) and Caribbean (n=40) infants, African ethnicity was associated with lower rates of BPD (p=0.011) and of BPD or death (p=0.014) compared with White ethnicity. Caribbean infants had the highest rates of mechanical ventilation (p=0.017) and use of inhaled nitric oxide (p=0.039), and longer durations of mechanical ventilation (p=0.003) and admission (p=0.047), but had similar odds of BPD or of BPD/death to White infants (p=0.98 and p=0.73, respectively). Conclusions In this UK cohort of preterm infants, respiratory outcomes differed by ethnicity. Further work is needed to identify the genetic, environmental and structural drivers of these difference so that interventions can be appropriately targeted.