For preterm infants, newborns with congenital anomalies, or babies who develop complications after delivery, access to a neonatal intensive care unit (NICU) can literally mean the difference between life and death. The specialized staff and equipment available at NICUs is essential for infants with these and other complex medical needs, but a new study from the University of Minnesota School of Public Health (SPH) shows that many people in rural America live far from hospitals equipped with these potentially life-saving facilities.
To conduct the study, SPH researchers analyzed data from a nationally-drawn survey of 89 rural hospitals with childbirth services in the U.S. The survey, which was conducted between March and August of 2021, asked hospital administrators and maternity unit managers to report the distance to their nearest NICU. They also analyzed additional hospital- and county-level data to assess how the characteristics of surveyed hospitals, and the communities in which they are located, related to NICU proximity.
The study, published in the Journal of Perinatology, found:
- Most rural hospitals were far from NICU care. More than half of surveyed rural hospitals were located over 60 miles from the nearest NICU, and an additional third were between 30-60 miles away. Only five of the surveyed rural hospitals had a NICU onsite.
- Hospitals farther from NICUs tended to have fewer resources. Facilities more distant from NICUs more often had smaller birth volumes, fewer beds, and higher proportions of Medicaid-paid births, indicating more limited hospital resources and capacity.
- Hospitals without nearby NICUs tended to be located in less-resourced communities. Hospitals lacking close NICU access were more often located in less-populated rural counties without a town of at least 10,000 people, and in counties with higher poverty rates, lower median household incomes, and higher unemployment levels.
“As rural communities face rising infant mortality and declining access to obstetric services, understanding how far families must travel for advanced newborn care has never been more important,” said Emily Sheffield, lead author and researcher at SPH’s Rural Health Research Center. “Rural infants born in communities with fewer resources tend to face higher health risks than those born in urban or more socioeconomically advantaged communities. Our findings show that these infants may also be located far from life-saving neonatal care if it is needed, which points to the importance of understanding and increasing rural residents’ access to these services.”
Not all rural hospitals need or can safely maintain a NICU, as many may not have sufficient birth volumes or neonatal clinical specialists to provide this care. In light of these capacity limitations, the paper includes policy recommendations and other strategies for improving rural neonatal care access, including strengthening regional referral systems, expanding maternal and neonatal transport services, increasing telemedicine support from neonatal specialists, and offering simulation training to bolster rural clinicians’ skills in stabilizing newborns while awaiting transfer to a hospital with a NICU.
It also recommends that future research should examine how distance to NICU care affects infant outcomes and explore effective models for supporting rural hospitals and emergency transport systems in regions located far from NICUs.
Funding support for this research was provided by the Federal Office of Rural Health Policy at the Health Resources and Services Administration, and by the National Institutes of Health’s National Center for Advancing Translational Sciences.
