Local availability of neonatal intensive care at rural hospitals with childbirth services

To compare hospital- and county-level characteristics of rural US hospitals based on distance to the nearest neonatal intensive care unit (NICU).

Cross-sectional analysis using data from a survey conducted March-August 2021 with administrators and maternity unit managers at rural hospitals with childbirth services (N = 89).

Few hospitals had a locally available NICU (onsite: n = 5, 5.6%; <10 miles: n = 0; 10-29 miles away: n = 5, 5.6%). Most were located ≥30 miles away from the nearest NICU (30-60 miles: n = 29, 32.6%; >60 miles: n = 50, 56.2%). All Critical Access Hospitals and hospitals in noncore (less populated) counties were ≥30 miles from NICUs. Hospitals further from NICUs more often had smaller birth volumes, higher proportions of Medicaid-paid births, fewer beds, and higher county-level proportions of lower income or unemployed residents.

Most surveyed rural hospitals did not have locally available NICUs, and characteristics of those that did suggest more hospital and community resources.