HMN 2025: How Rural residents have less access to neonatal intensive care

For many newborn infants, access to a neonatal intensive care unit (NICU) can mean the difference between life and death. The specialized staff and equipment available at NICUs are essential for infants with complex medical needs, but a new study from the University of Minnesota School of Public Health shows that many people in rural America live far from hospitals equipped with these potentially life-saving facilities.

To conduct the study, researchers analyzed data from a 2021 survey of 89 rural hospitals with childbirth services in the U.S. The survey asked hospital administrators and maternity unit managers to report the distance to their nearest NICU. The researchers also analyzed additional hospital- and county-level data to assess how the conditions of a local community and the amount of resources in the community related to NICU proximity.

The study, published in the Journal of Perinatology, found:

• Most rural hospitals are far from NICU care. More than half of surveyed hospitals were located over 60 miles from the nearest NICU, and a third of rural hospitals were between 30 and 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 had smaller birth volumes, fewer beds and higher proportions of Medicaid-paid births, indicating more limited hospital resources and capacity.
• Communities without nearby NICUs faced greater socioeconomic disadvantages. Hospitals lacking close NICU access were more often located 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 a researcher at the School of Public Health’s Rural Health Research Center. “Infants born in communities with fewer resources not only face greater risks, but are often the farthest from the life-saving neonatal care they may urgently need.”

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.

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