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NeoReviews EDI Case Series Discusses Inequities in the NICU

November 25, 2022

Eliminating inequities in healthcare requires we address and discuss them in an open, honest, and often uncomfortable way. We invite you to sit with us in the discomfort necessary for change.

This month, NeoReviews is launching a new case series devoted to equity, diversity, and inclusion in newborn care. The disparities in infant health outcomes related to race, ethnicity, gender, and/or socioeconomics often start with how we treat and care for neonates. Many of these differences do not result from conscious decisions, but rather from unconscious biases. This case series is designed to address not only care given to birth parents but the care given to their families in the postpartum period.

Each of the cases chosen for this series are real life examples of inequities in care delivery for newborns. In the first of this series, Equity in Policies Regarding Urine Drug Testing in Infants, Murosko et al (authors from this blog co-wrote this article) present the true case of a pre-term neonate displaying fussiness and intermittent jitteriness in the NICU whose medical team elects to screen for drugs. The case is followed by brief author perspectives, objectives, and key terms.

The author perspective request to “put yourself into the perspective of the infant’s birth parent” and is used to launch a discussion on screening infants for neonatal abstinence syndrome and how a family might view a urine drug screen being collected on their infant without their knowledge.

In the bulk of the article, we discuss care practices and interactions with families, focusing on when and how individual biases and systemic practices introduced inequities. This discussion is enhanced by opportunities for readers to reflect on their own biases and systems and is supported by a brief review of relevant literature.

The literature review offers readers a comprehensive look at:

  • How care delivery is influenced by factors outside of medication orders and laboratory tests.
  • The history of discrimination and bias that drives how we frame care for families.
  • The need for readers to consider how these processes continue to drive inequities.
  • The skills required to change the way we think of care delivery with a focus on equity.

Along with the review of current literature around NICU drug testing, healthcare leaders in the field were invited to further open the dialogue. While the original authors provide reflections on the newborns’ care at their hospital, the healthcare leaders elevate this discussion by adding their perspectives and insights into the case based on their experiences and research in the topic. This format provides dynamic and diverse views on the case and a framework for others to have in-depth conversations about how their own healthcare system would have differed in their care delivery. The case closes with concrete tips for eliminating inequities that can be enacted by individuals, care teams, or unit leaders.

As you read the first of this case series, pause to think of times when you felt an infant didn’t get the care they required because of factors out of their control: race; living situation; parent’s inability to be present for family meetings or lack of access to paid family leave or transportation, or even their zip code. Interested in submitting a case? Please email neoreviewseditorial@aap.org.

Additional blog authors: Diana Montoya-Williams, MD, MSHP, Division of Neonatology, Children’s Hospital of Philadelphia; Joanna Parga-Belinkie, MD, IBCLC, Division of Neonatology, Children’s Hospital of Philadelphia; Daria Murosko, MD, MPH, FAAP; Division of Neonatology, Children’s Hospital of Philadelphia

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