To the Editor.
—In the study by Dr Als and colleagues,1 only 17% (3/18) of the control group were black infants while 40% (8/20) of the experimental group, that is, those who received individualized developmental care, were black infants. This difference in distribution was dismissed as not significant (χ2, 2.51; P=.11). However, black, very low-birth-weight infants have lower mortality rates than white newborns of comparable weights nationally, and when compared internationally, the black, very small newborn also has lower mortality rates than those of other industrialized countries.2 Als et al have aggregated their black and white patients, ignoring longstanding epidemiological evidence that "quality of medical care cannot be evaluated in a meaningful way using aggregated data."3Not surprisingly, lower mortality rates are associated with lower morbidity. Black premature infants have significantly less hyaline membrane disease than white premature infants. In addition, the disease is less
Sepkowitz S. Developmental Care for Very Low-Birth-Weight Infants. JAMA. 1995;273(20):1577. doi:10.1001/jama.1995.03520440027022