Hospitals often cannot see the social inequities harming their sickest newborns because they rarely document key sociodemographic data, according to an American Academy of Pediatrics clinical report published July 20.
The report, “Social Inequities in High-Risk Neonatal Care Delivery,” calls those inequities “unacceptable” and lays out evidence-based strategies for closing them. It will appear in the August issue of Pediatrics.
A central problem, the authors said, is measurement. Infant race and ethnicity are rarely captured in the infant’s own medical record, and most neonatal quality-tracking systems use maternal race and ethnicity as a proxy.
That approach is inherently inaccurate, the authors said. Because maternal identifiers are the easiest to pull from administrative records, most population-level studies rely on them alone, obscuring the intersecting factors that drive poor outcomes and curtailing efforts to design interventions.
The stakes are concentrated in the neonatal ICU. Preterm and low birth weight infants are much more likely to be born to low-income or racially and ethnically minoritized families. Citing CDC data, the report said 47% of very low birth weight infants — those weighing 1,500 grams or less — are born to families living below 200% of the federal poverty level. Additionally, 41% of families with a very low birth weight infant report household financial hardship, compared to 20% of families with term infants.
To close the gaps, the report urges hospitals to improve the accuracy of sociodemographic data and routinely track quality outcomes by factors including race, ethnicity, insurance type and preferred language. Other recommendations include hiring bilingual clinicians with tested proficiency and using credentialed medical interpreters for every encounter.
The authors also called for required multidisciplinary anti-bias training rather than opt-in sessions, expanded family-centered care, and standardized screening for adverse social drivers of health during the hospitalization. They noted that many very low birth weight infants qualify for Supplemental Security Income but never receive it, and urged clinicians to help families apply before discharge.
The authors acknowledged that several recommendations may require funding or staffing beyond what many units have today — framing the gaps as a case for institutional investment as much as a clinical to-do list.
The report was sponsored by the AAP Committee on Fetus and Newborn and Council on Health Equity.
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