Neonatal mortality rates were higher in hospitals in which most very low birth weight
infants were black.
Black and Hispanic infants received breast milk at lower rates than white infants.
Black mothers reported limited breastfeeding support.
Minority breast milk feeding rates improved in hospitals with more white mothers.
Hospitals with large numbers of black patients experienced more nurse understaffing
than hospitals with low numbers of black patients.
Referrals for early intervention were lower for black and Hispanic infants with very
low birth weight than white infants.
Black infants had a two-fold greater risk of dying from intraventricular hemorrhage
than white infants.
Survival rates for infants with necrotizing enterocolitis were lower for Hispanic
infants than non-Hispanic infants.
Authors noted two themes.
"First, infants of color, especially black and Hispanic infants, are more likely to
receive care in quality-challenged hospitals," they wrote. "Second, disparities also
exist within NICUs."
Some of these disparities could be fixed by improving hospital processes.
“Researchers are now looking at chronic stress caused by societal, institutional or
interpersonal racism as causal factors for preterm birth and this review suggests
that these factors are also causal factors for racial/ethnic disparities in NICU quality
of care,” according to the study. “Targeted quality improvement efforts hold promise
for improving racial/ethnic equity in care delivery.”
In a related commentary, experts from the Centers for Disease Control and Prevention’s Division of Reproductive
Health recommend requiring all hospitals to participate in quality improvement initiatives,
implementing best practices, ensuring infants are cared for in facilities that can
best address their needs and expanding research into the causes of disparities in
"Quality improvement for adult patient care has revealed, when implemented with a
specific eye on 'closing the gap,' that disparities can be reduced," they wrote. "We
owe the infants of this country consistent high-quality care, no matter their skin
color, and this article documents that there is work to be done."