Why Premature Babies Who Aren't White Get Worse Care

Baby hand in an adult hand

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In the U.S., one out of every 10 babies is born prematurely, or before 37 weeks of pregnancy. Infants who are born prematurely are at higher risk of facing serious health consequences and developmental issues after birth.

If a baby born prematurely needs extra medical care and attention, they will most likely be admitted to a neonatal intensive care unit, or NICU. Stays in the NICU will vary depending on the baby's condition and health needs, but one thing is for certain: Babies in the NICU need all the help and medical care they can get.

And unfortunately, data has revealed that not all babies in the NICU have equitable care. One reason? Race. Research has revealed preemies of color are more likely to be treated at lower-quality NICUs and have worse health outcomes once there.

Black babies are less likely to thrive in NICUs despite being more likely to need the care they provide: The preterm birth rate is 49% higher among Black people than all other people in the U.S.

What the Research Says

A landmark review of 41 studies, led by Stanford University researchers and published in Pediatrics in 2019, focused on racial and ethnic disparities in NICU care. Researchers found some patterns when looking at these varied studies from across the country and over time.

Their key findings were that premature infants of color, particularly Black and Hispanic babies, are more likely to be treated in hospitals that have lower quality standards and ratings. In addition, the patient-to-nurse ratio is significantly higher in NICUs that serve mainly Black families.

Black preemies are generally at higher risk for health problems, including intraventricular hemorrhage, congenital heart disease, and dying from lack of a needed intestinal transplant. However, they are less likely than other babies to die of respiratory distress syndrome and retinopathy of prematurity.

White preemies are more likely to survive than preemies of other ethnicities, however one study in the review showed that among pre-term infants born before 28 weeks, Black and multiracial infants have a higher survival rate.

Non-white families of preemies seem to receive less support in the hospital. Black families in particular report feeling a lack of compassionate and respectful communication in NICUs.

When compared to White parents, both Black and Hispanic parents were less likely to leave NICUs having established a successful, regular breastfeeding practice with their babies.

Explanations and Possible Solutions

Race-linked risk factors for certain health conditions explain some of the disparity in how well babies do in the NICU. For instance, Black babies are genetically more vulnerable to intraventricular hemorrhage than White babies and less vulnerable to respiratory distress syndrome.

However, NICU quality seems to play an outsized role in how well pre-term babies fare. Authors of one study that was highlighted in the research review estimate that differences in access to high-quality NICUs accounts for about 30 to 40% of racial disparity when it comes to preemies' health outcomes.

Non-white babies might be suffering from institutional racism that can cause everything from lesser resources at community hospitals to chronic stress that can trickle down to the youngest among us.

Researchers suggest several actions to help support preemies in these situations, including educating administrators at NICUs with high proportions of non-White babies to use better quality improvement (QI) tools that are frequently employed at high-quality hospitals.

In addition, employing more family-centered care strategies in NICUs may improve satisfaction and health outcomes. More research is needed to separate the effects of socio-economic status and education from race and ethnicity. This will hopefully give experts a clearer picture of why babies of color often lose out on excellent care.

A Word From Verywell

We all owe a debt of gratitude to researchers who make it their life's work to explore racial inequality can affect medical care. It's hard, but important, to recognize that even the littlest and most vulnerable among us may receive lesser medical care for reasons linked to race.

If you are expecting a baby, it's a good idea to do research on how you might gain access to a high-quality NICU. NICUs are rated on a scale of 1 to 4, with Level 4 NICUs offering the most resources for high-risk preemies. Remember, your research and advocacy can help your preemie thrive no matter who you are or where you live.

2 Sources
Verywell Family uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. March of Dimes. 2020 Report Card.

  2. Sigurdson K, Mitchell B, Liu J, et al. Racial/ethnic disparities in neonatal intensive care: a systematic reviewPediatrics. 2019;144(2):e20183114. doi:10.1542/peds.2018-3114.

Additional Reading

By Chaunie Brusie, RN
Chaunie Brusie is a registered nurse with experience in long-term, critical care, and obstetrical and pediatric nursing.