Language access in the neonatal intensive care unit: inequities, legality, practice, and call to action

Evaluate Neonatal Intensive Care Unit (NICU) interpreter access and utilization, unit-based interpreter policies and initiatives, staff awareness and confidence in understanding language-access laws, and perceptions of language-based inequities.

An exploratory national survey of NICU staff was distributed via the National Association of Neonatal Nurses and the American Academy of Pediatrics (AAP) (10/2024-4/2025). Descriptive statistics and qualitative analysis were used for survey results.

The 189 respondents represented all ten AAP districts. Most were aware of NICU-based interpreter policies (76%). 81% were not aware of additional state laws/provisions and many lacked confidence understanding federal (43%) or state (63%) language-access laws. Many respondents disagreed that language-discordance resulted in worse quality of care (40%) and outcomes (59%) in their NICU.

Results highlight the need for additional education on federal and state laws and provisions as well as the broad and systemic nature of language-based healthcare inequities across institutions.