A disproportionate number of very-low-birth-weight infants in the United States are black. Researchers investigated whether very-low-birth-weight infants (of any race) born in hospitals with high concentrations of black very-low-birth-weight infants have poorer perinatal outcomes and, if so, whether nurse staffing or other hospital characteristics contribute to outcome disparities in this high-risk population.

In a retrospective study, they evaluated two nurse-sensitive perinatal outcomes-nosocomial infection and being discharged without being fed breast milk-in 8,252 very-low-birth-weight infants (mean birth weight, 1,078 g) cared for in 98 neonatal ICUs (NICUs) nationwide. Both outcomes are associated with significant morbidity and mortality. The hospitals were classified into three groups-"low-black," "medium-black," and "high-black"-according to the proportion of very-low-birth-weight infants treated who were black. NICU nursing characteristics were determined from a Web-based survey of 5,773 nurses.

Infection rates were significantly higher in high-black hospitals than in low-black hospitals (18% versus 14%), and significantly more infants were discharged not on breast milk (63% versus 43%). Both black and nonblack infants had worse outcomes in high-black hospitals.

Nurse understaffing was higher and practice environments were worse in high-black than in low-black hospitals. After adjustment for possible confounding variables, NICU nursing characteristics accounted for one-third to one-half of hospital-level health disparities. The authors conclude that improvements in nursing resources in hospitals with high concentrations of black very-low-birth-weight infants could improve outcomes in 70% of such infants born in the United States.

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