Editorial "Neonatal Outcomes - What About Sex, Race(ism) And Social Determinants of Health?

Rachana Singh^*

• School of Medicine, Tufts University, Boston, United States

While majority of newborns are born healthy at term gestational age, with the advancement of medical/surgical interventions in neonatal care, many newborns with complex disorders at birth are now able to survive albeit with potential for long term ongoing morbidities and at risk for neuro-developmental deficits (1). These are seen in the increased survival of preterm infants with associated complications of pre-term birth as well as term infants with congenital medical and surgical disorders (2-4). There is some growing evidence that variations in the neonatal outcomes cannot be solely explained just on the illness severity and clinical interventions. There likely are additional factors in play that can negatively impact outcomes and identifying some modifiable risk factors could help mitigate the inequities in outcomes (5-7). Also, knowing well that race is a social construct, it is very commonly reported in ongoing studies and can lead to biases in care provision (8).Currently, there is a limited body of literature highlighting the influences of neonatal sex, race(ism) and maternal Social Determinants of Health (SDoH) on neonatal outcomes. It is a common adage in Pediatrics that male infants will have a relatively poor outcome as compared to female infants -why is still unanswered. Historically, race has been tied in with health outcomes sending erroneous message with a huge impact on care provision to people of color and minorities. Lastly, disparities in accessing healthcare based on one's socioeconomic status and neighborhood one lives in are documented for adults and children. The aim of this research topic was to describe the scientific rationale about the role infant sex plays; how we can eliminate race(ism) as influencing outcomes and lastly address how we can effectively address SDoH related modifiable factors by early identification and creating public health policies to support the families and newborns affected by it.In exploring the role of sex on neonatal outcomes, it is quite obvious that the complexity of interplay between the maternal-placental-offspring factors are closely tied in with neonatal sex, especially when focusing on specific neonatal disorders. [Madurai, Alur]. Fetal sex, either secondary to chromosome specific gene activation/deactivation regulation and/or genetic material, can alter placental functioning thereby impacting both maternal and fetal health (9,10).Studies focusing on maternal pregnancy outcomes based on fetal sex have demonstrated higher cardiovascular and metabolic load for the mother with poor obstetric outcomes including but not limited to pregnancy induced hypertension, gestational diabetes, and preterm birth (11,12). The survival advantage as well as other morbidities in the neonatal period demonstrate a propensity for poorer outcomes for male infants as compared to female infants (13) Awareness of these sex-based differential outcomes can help advance the field of personalized medicine with the intent of better prognostication and guiding therapies (14,15). While race is well known to be a social construct, it continues to be reported in medical literature as having biological plausibility and thereby leading to inequities in healthcare provision, utilization and outcomes (16)(17)(18)(19). When delving deeper, it quickly becomes apparent that the differences reported by race are likely secondary to socio-economic disparities, access to care and health literacy. [Call, Konzett, Li] By focusing on these modifiable factors through guided resource utilization an improvement in neonatal outcomes can be achieved. [Belay, Wogayehu] In high income countries there has been a steady improvement in neonatal outcomes, which continues to be sustained even with lowering limits of viability and complexities of neonatal diagnoses. [Li, Konzett] With the significant advances made in the fields of genetics and epigenetics, it is time to incorporate these biological variables in future research rather than continuing to focus on race based outcomes (20). Not only will this strategy improve diagnostics but also allow for better targeted therapeutic opportunities (21)(22)(23).Thus, the future of neonatal care improvement not only warrants incorporating personalized medicine methodologies by focusing on biological variables while developing therapeutics but by also systematically eradicating the inequities that persist secondary to socioeconomic status.