Nursing Improvements Could Boost Outcomes for 7 Out of 10 Critically Ill Black Babies

    • September 23, 2014
A mother stands by a crib, holding her infant in her arms.

Princeton, N.J.—Identifying the reasons for racial health disparities and ways to address them is a significant, complex challenge in health care. A new study in the journal Health Services Research provides insight into the issue of very low birth weight (VLBW) infants, who are disproportionately black, and finds that it’s not just their race that’s a factor in their health outcomes, it’s the quality of care at the hospitals where they’re born.

The study, funded by the Robert Wood Johnson Foundation’s Interdisciplinary Nursing Quality Research Initiative and the National Institute of Nursing Research, incorporated data on 8,252 VLBW infants in 98 neonatal intensive care units (NICUs) throughout the country and the results of a survey of 5,773 NICU nurses. Researchers found that nurse understaffing and practice environments were worse at hospitals with higher concentrations of black patients, contributing to adverse outcomes for VLBW infants born in those facilities.

Since 7 out of 10 black VLBW infants are born in hospitals with a high concentration of black patients, researchers concluded that improvements in nursing at such hospitals have the potential to boost the quality of care for many black VLBW infants. The study looked at two nurse-sensitive perinatal quality standards—hospital-acquired infection and discharge without having started breast milk—which have long-term health implications for VLBW infants. They found higher rates of both in high-black-concentration hospitals. NICU nursing features ultimately accounted for one-third to one-half of hospital-level health disparities.

The interdisciplinary research team was led by Eileen T. Lake, PhD, RN, FAAN, professor of nursing and health policy, and associate director of the Center for Health Outcomes and Policy Research at the University of Pennsylvania School of Nursing, and Jeannette A. Rogowski , PhD, University Professor in the Department of Health Systems and Policy in the School of Public Health at Rutgers University. The team also included Jeffrey Horbar, MD, professor of pediatrics, University of Vermont; Michael Kenny, MS, research biostatistician, University of Vermont; Thelma Patrick, PhD, RN, associate professor, the Ohio State University College of Nursing; and Douglas Staiger, PhD, professor of economics, Dartmouth College.

“Very low birth weight infants are at a high risk for a lifetime of health challenges,” said Lake. “The birth hospitalization is the starting point.  With a high number of black infants born in relatively few hospitals, tackling a previously unaddressed question—do infants cared for in hospitals with a high concentration of black infants have poorer perinatal quality outcomes?—gives us an opportunity to make a positive impact on population-level health disparities.”

The study highlights dramatic differences in the distribution of care for black infants, with nearly three-fourths of black VLBW infants born in a third of hospitals that care for critically ill newborns. Only 1 in 20 black infants are born in hospitals with better nursing characteristics, and odds of adverse outcomes related to nurse-sensitive perinatal quality standards are at least 60 percent higher for infants born in disproportionately black hospitals.

About the Robert Wood Johnson Foundation

For more than 40 years the Robert Wood Johnson Foundation has worked to improve the health and health care of all Americans. We are striving to build a national Culture of Health that will enable all Americans to live longer, healthier lives now and for generations to come. For more information, visit Follow the Foundation on Twitter at or on Facebook at

Media Contacts

Melissa Blair

Robert Wood Johnson Foundation (609) 627-5937