NANN Position Statement: Racial Disparity in the NICU: Position Statement #3070


In 2020, the National Association of Neonatal Nurses (NANN) published a new position statement, titled “Racial Disparity in the NICU,” which reviews the statistics concerning racially related health disparities for premature infants and includes 9 recommendations for how to endorse healthcare equality for all infants in the neonatal intensive care unit (NICU) regardless of race, parental economic or education status, or geographic area.

Despite medical advances in the field of neonatology, prematurity remains a problem in the United States. In 2019, a Centers for Disease Control and Prevention (CDC) report documented that one of every 10 infants in the United States was born prematurely, with statistics continuing to demonstrate disparate racial and ethnic differences in preterm birth. In 2019, the rate of preterm birth among African American women (14.4%) was about 50% higher than the rate of preterm birth among White or Hispanic women (9.3% and 10%, respectively).1

Preterm birth is identified as a leading cause of infant mortality, defined as death before 1 year of age. The majority of infant deaths occur within the neonatal period, the first 28 days. A CDC report on infant mortality2 showed that infants of African American mothers had the highest mortality rate (10.75), followed by Native Hawaiian or Pacific Islander (9.39), and non-Hispanic American Indian or Alaskan Native (8.15). This compares with lower rates for Hispanic (4.86), non-Hispanic White (4.63), and non-Hispanic Asian (3.63) infants. The differences in maternal–infant risk factors, especially the rates of prematurity, are the most important driver of racial/ethnic disparities in neonatal and infant outcomes.3

Along with racial disparities in preterm birth rates and infant mortality, several studies have shown that racial inequities in outcomes exist between hospitals as well as within NICUs. Horbar et al4 conducted a large cohort study including 743 NICUs in the Vermont Oxford Network, with 117,982 Black, Hispanic, Asian, and White infants born at 401 to 1500 g or 22 to 29 weeks’ gestation from January 2014 to December 2016. Black, Hispanic, and Asian infants were segregated across geographic regions and NICUs, reflecting the racial segregation of minority populations in the United States. This study demonstrated large differences between regions and NICU quality of care, with Black very low birth-weight infants receiving care in NICUs with lower outcome quality measures than White infants. Disparities in neonatal outcomes have also been shown to be evident among other racial/ethnic groups of color. These disparities are long-standing and complex, with a multifactorial basis.

Neonatal nurses are advocates for our patients and their families. We must explore personal or implicit bias, provide and seek education on cultural diversity, and address systems and policies that have given rise to racial and ethnic health inequities. In our neonatal units, we can commit to quality improvement by examining individual NICU statistics to evaluate significant trends in gestational age, race, and patient outcomes.

Ref: doi: 10.1097/ANC.0000000000000955