Improving infant health equity: what have we learned, what do we do

The United States neonatal and infant mortality rates have declined substantially over the last six decades. Despite these reductions, significant racial disparities in mortality and other important outcomes have persisted. While increased risk of preterm birth is a major contributor to these differences, racial inequities in risk-adjusted outcomes such as gestational age-specific and major congenital anomaly-associated mortality remain. Race-specific differences in inter- and intra-neonatal intensive care unit (NICU) practices associated with worse outcomes for infants of color suggest opportunities for reducing these disparate health outcomes during and after NICU hospitalization. Identifying NICU-based contributing factors and implementing factor-specific improvement strategies can lead to more equitable outcomes. In this review, we describe examples of racial inequities in risk-adjusted NICU outcomes and inter- and intra-NICU practices associated with worse outcomes for infants of color, provide an overview of current approaches to health equity in NICU care, and identify opportunities, sustainable strategies, and accountabilities for more equitable care and support of NICU patients and, quite importantly, their families. IMPACT: Characterize racial inequities in risk-adjusted neonatal intensive care unit (NICU) outcomes and inter- and intra-NICU practices associated with worse outcomes for infants of color. Provide an overview of current trends in and approaches to health equity in NICU care. Discuss strategies for implementing and sustaining more equitable care and support for infants and families during NICU hospitalization.