New National Standards For Neonatal Intensive Care Aim To Achieve Health Equity For US Newborns

BIDMC Neonatologist Convened the Team of Experts To Develop New Standards For the American Academy of Pediatrics

BOSTON – The United States ranks 35th in neonatal mortality among developed nations; more than three babies out of every 1,000 babies die within their first month of life. Many factors contribute to these shocking numbers, however, experts agree one reason is the lack of national standards for neonatal intensive care units (NICUs). While all states regulate health care facilities, specifications for levels of neonatal care vary widely, and few states require verification by a third-party agency.

Now, new standards for levels of neonatal care that specify the personnel, equipment and services hospitals need to provide for newborns and families have been established by a team of neonatal leaders and experienced clinicians led by Ann R. Stark, MD, a neonatologist at Beth Israel Deaconess Medical Center (BIDMC) in her capacity as medical director of the NICU Verification Program for the American Academy of Pediatrics (AAP). Based on AAP policy, evidence-based literature and standards of professional practice, Standards for Levels of Neonatal Care: II, III, & IV, appeared in the AAP’s journal Pediatrics.

“We have created these standards with a goal to improve outcomes, increase access to care, improve standardization across all levels of neonatal care and achieve health equity for babies across the country,” said Stark, “We were concerned that first, all babies should be treated in a place with appropriate care and second, that the facility has the people and the equipment that are appropriate for their degree of illness or immaturity.”

AAP’s NICU Verification Program already performed third-party surveys by experts, including neonatologists, neonatal nurses and pediatric surgeons, assessing whether facilities in Texas comply with state standards for neonatal care. As the need has grown and more facilities outside of Texas have requested surveys, it became clear that the AAP needed to develop national neonatal care standards. The publication of the AAP NICU standards marks the beginning of the AAP NICU Verification Program’s endeavor to expand nationally.

With publication of the new standards, and when processes are in place, the AAP program will be able to verify a neonatal facility’s compliance and designate that it provides a specific level of neonatal care (II, III or IV). Hospitals will submit data and undergo a survey of their facility. Those that meet requirements will be able to state that they are AAP-verified at a particular level of neonatal care. The designation then will be transparent to physicians and families deciding where to deliver and/or seek care for their baby.

“Parents should understand the level of neonatal care available where they are delivering,” said Stark. “Whether they are born in urban academic medical centers or rural community hospitals, all babies deserve optimal care. Adoption of the AAP neonatal standards is a vital step toward high-quality and equitable care.”

Co-authors included DeWayne M. Pursley, MD, MPH, and Roseanne K. Buck, RN, MS, NNP-BC, C-ONQS of BIDMC; Lu-Ann Papile, MD, of University of New Mexico; Eric C. Eichenwald, MD, of Children’s Hospital of Philadelphia; Charles T. Hankins, MD, MBA, of Children's Hospital of San Antonio; Tamara J. Wallace, DNP, APRN, NNP-BC, of Nationwide Children's Hospital; Patricia G. Bondurant, DNP, RN, of TransForm Healthcare Consulting, LLC; Nicole E. Faster, MSN, RN, RNC-NIC of the American Academy of Pediatrics.

Adapted from content published by the American Academy of Pediatrics.