Disparities in perinatal quality outcomes for very low birth weight infants in neonatal intensive care

Health Serv Res. 2015 Apr;50(2):374-97. doi: 10.1111/1475-6773.12225. Epub 2014 Sep 22.


Objective: To determine if hospital-level disparities in very low birth weight (VLBW) infant outcomes are explained by poorer hospital nursing characteristics.

Data sources: Nurse survey and VLBW infant registry data.

Study design: Retrospective study of 8,252 VLBW infants in 98 Vermont Oxford Network hospital neonatal intensive care units (NICUs) nationally. NICUs were classified into three groups based on their percent of infants of black race. Two nurse-sensitive perinatal quality standards were studied: nosocomial infection and breast milk.

Data collection: Primary nurse survey (N = 5,773, 77 percent response rate).

Principal findings: VLBW infants born in high-black concentration hospitals had higher rates of infection and discharge without breast milk than VLBW infants born in low-black concentration hospitals. Nurse understaffing was higher and practice environments were worse in high-black as compared to low-black hospitals. NICU nursing features accounted for one-third to one-half of the hospital-level health disparities.

Conclusions: Poorer nursing characteristics contribute to disparities in VLBW infant outcomes in two nurse-sensitive perinatal quality standards. Improvements in nursing have potential to improve the quality of care for seven out of ten black VLBW infants who are born in high-black hospitals in this country.

Keywords: Health disparities; VLBW infants; nurse practice environment; nurse staffing; quality standards.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • African Americans / statistics & numerical data*
  • Breast Feeding / ethnology
  • Breast Feeding / statistics & numerical data*
  • Clinical Protocols
  • Cross Infection / epidemiology
  • Healthcare Disparities / ethnology
  • Healthcare Disparities / statistics & numerical data*
  • Humans
  • Infant
  • Infant, Newborn
  • Infant, Very Low Birth Weight*
  • Intensive Care Units, Neonatal / statistics & numerical data*
  • Nursing Staff, Hospital / statistics & numerical data*
  • Personnel Staffing and Scheduling / statistics & numerical data
  • Quality of Health Care
  • Retrospective Studies
  • Vermont
  • Workload / statistics & numerical data