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NICUs Serving Primarily Black Families Have More Dangerous Nurse-to-Patient Ratios

That mothers and babies of color experience much higher maternal and infant mortality rates than their white counterparts has been well-documented.

Mothers and babies of color experience much higher maternal and infant mortality rates than their white counterparts has been well-documented. In addition, black babies are more likely to be born prematurely. And now, research is indicating that minority children who end up in the NICU receive less effective care than whites.

What Did the Study Find?

A review published in Pediatrics of 40 existing studies found numerous disparities in the care of minority infants in neonatal intensive care units. The research also suggested that these differences exist across NICU structure, processes, and outcomes — usually to the disadvantage of non-white, especially black and Latino, infants. Overall, black and Latino babies were more likely to stay in quality-challenged hospitals than white babies.

According to a statement on the research from the American Academy of Pediatrics, the most noteworthy findings include:

  • Hospitals with large numbers of black patients experienced more nurse understaffing than hospitals with low numbers of black patients.
  • Neonatal mortality rates were higher in hospitals with primarily black infants with very low birth weight.
  • Black infants were more likely to be born in hospitals with higher mortality and morbidity rates.
  • Breastfeeding rates were lower for Latino than white mothers and lowest for black moms, who reported receiving limited breastfeeding support.
  • Minority breast milk feeding rates were higher in hospitals with more white mothers.
  • Black and Latino infants with very low birth weights were less likely to receive referrals for early intervention than white infants.
  • Black infants were two times more likely to die from intraventricular hemorrhage than white infants.
  • Non-Latino infants with necrotizing enterocolitis had higher survival rates than Latino infants.

Why Does the Study Matter?

While these points are disturbing, the authors noted that they’re “only the tip of the iceberg” because the study results only reflect what’s been measured.

“There are many areas of disparities that are currently not routinely and systematically measured, such as respectful, family-centered care,” explained coauthor Krista Sigurdson, Ph.D., a research fellow at California Perinatal Quality Care Collaborative, in a statement.

Added coauthor Jochen Profit, MD, MPH, professor of pediatrics at Lucille Salter Packard Children’s Hospital: “Care delivery is amenable to change by NICU providers and therefore holds promise for improving outcomes among vulnerable infants … Our study demonstrates that disparities in care delivery are pervasive and that the NICU setting is not … a social cocoon.”

One potentially important change may begin with more research, according to the authors: “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,” they wrote in the Pediatrics article. “Targeted quality improvement efforts hold promise for improving racial/ethnic equity in care delivery.”

What Can Clinicians Do About Racial Disparities in Healthcare?

There isn’t a simple or even single way to eliminate racial biases from your behavior at work. But important first steps to ensure you’re providing equal care are to learn about racial health disparities and to ask questions, according to Juliette G. Blount, RN, MSN, NP, who discussed the concept at the American Association of Nurse Practitioners’ annual conference in June.

Pulling from, Blount defined “health disparity” as:

“A particular type of health difference that is closely linked with social, economic, and/or environmental disadvantage. Health disparities adversely affect groups of people who have systematically experienced greater obstacles to health based on their racial or ethnic group; religion; socioeconomic status; gender; age; mental health; cognitive, sensory, or physical disability; sexual orientation or gender identity; geographic location; or other characteristics historically linked to discrimination or exclusion.”

Blount also has made a habit of talking to patients about their backgrounds, which helps her understand how they see themselves and potential risk factors. She asks about the following:

  • Ethnicity/heritage.
  • Culture, or the factors that influence a patient’s lived experience, such as their religion or where they grew up.
  • Preferred terms to refer to their ethnicity, culture, etc.

Acknowledging racial differences can be uncomfortable, but without it, people of color won’t receive the health equity they deserve. As Blount put it, “Talking about it is not going to kill you. But not talking about race is going to kill patients.”

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