Differences in NICU quality and access leads to racial disparities in neonatal outcomes

1. A systematic review found multiple studies showing that infants of color had lower access to high-quality care and were more likely to receive care in quality-challenged hospitals. The patient-to-nurse ratio was significantly higher in black-serving NICUs.

2. The review found that disparities also existed within NICUs: low birth weight infants born to black mothers were less likely to receive early intervention referrals, and black mothers reported receiving limited breastfeeding education and support.

Evidence Rating Level: 2 (Good)

Study Rundown: Disparities due to race and ethnicity have been studied in many areas of health care, including cancer care, cardiovascular care, and pediatric care. However, less is known about the disparities due to race and ethnicity in NICU care. In this systematic review, researchers identified 41 studies of interest that reported quality of NICU care with data stratified by race and/or ethnicity. Data was extracted for review, but no meta-analysis was conducted due to study heterogeneity. Key findings were that infants of color were more likely to receive care in quality-challenged hospitals, patient-to-nurse ratios were significantly higher in black-serving NICUs, infants of color had greater risk of overall morbidity or mortality, and low birth weight infants born to black mothers were less likely to receive early intervention referrals.

The study was limited by its exclusion of non-US data sources and non-English publications. Furthermore, the heterogeneity of studies prevented meta-analysis of data. Nonetheless, the study is strengthened by its large, representative sample of literature examining multiple outcomes. For physicians, these findings highlight the need to address racial differences in quality of care or access to high-quality care in NICUs that leads to preventable disparities in neonatal outcomes.

Click to read the study, published today in Pediatrics

Relevant reading: Trends in differences in us mortality rates between black and white infants

In-Depth [systematic review]: Researchers used publication databases to identify 566 studies that were focused on racial and/or ethnic differences in quality of NICU care published before March 2018; 41 studies of interest were ultimately included. These included studies using US data, published in English, which reported quality of NICU care (e.g. outcome measures, structural measures of care, patient evaluations of care, process-of-care measures, and direct observations of care). Studies were divided into structure-process-outcome according to their theme. Meta-analysis was not possible because of study heterogeneity.

Key findings were that infants of color were more likely to receive care in quality-challenged hospitals, and that disparities also exist within NICUs. In particular, multiple studies found that the patient-to-nurse ratio was significantly higher in black-serving NICUs, infants of color had greater risk of overall morbidity or mortality, low birth weight infants of black mothers were less likely to receive early intervention referrals, and black mothers reported receiving limited breastfeeding education and support.

Image: PD

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