1. Brandon, Debra PhD, RN, CCNS, FAAN
  2. Co-Editor
  3. McGrath, Jacqueline M. PhD, RN, FNAP, FAAN
  4. Co-Editor

Article Content

We celebrate the beginning of 2021 with the faith that our passion for excellence in provision of neonatal care will prevail in the hard work ahead. As with other age groups, infants in the neonatal intensive care unit (NICU) experience health disparities secondary to racism and inequalities.1-3 While this fact has been clear for years, recognition of how nurses and other neonatal healthcare providers contribute to health inequity and how we all have the responsibility to address health inequities has only recently come to the forefront. In this editorial, we are asking that everyone speak up against and take necessary steps to ameliorate the impact of inequity and racism in the NICU environment. Taking this stand may be uncomfortable for those of us who are privileged by the existence of racism, but it should not hinder the needed progress to support our infants, families, and colleagues.


Infant mortality is a key indicator of health in the United States and worldwide. Non-Hispanic Black infants die at more than twice the rate (10.8 per 1000 live births) of non-Hispanic White infants (4.6 per 1000 live births).4 While social determinates of health (discrimination, community deprivation, poor access to healthcare, limited educational, and economic opportunity) are leading contributors to health disparities in infants cared for in NICUs, they do not tell the entire story.1-3,5 Conventional risk factors (social determinates of health) place Black women and infants at a higher risk than their non-Hispanic White counterparts while conventional protective factors (high socioeconomic status and high education) are not as protective as they might be for other groups.5 Racial disparities in infant mortality and morbidity are often attributed to maternal engagement in "risky" behaviors (eg, drug abuse) or maternal comorbidities (obesity); yet, health disparities persist even after these factors are considered or amilerated.5 The biological and psychological stress of racism can explain this finding.


Given the impact of racism on the outcomes for our infants and families, we offer 3 resources to begin our journey to address NICU health disparities. First, NANN developed a position statement that provides 9 practical interventions that all NICUs can implement to address racial disparities:


1. Elevate awareness by encouraging open discussion;


2. Encourage diversity in the workforce;


3. Examine personal bias and beliefs; Be open to feedback;


4. Examine your NICU stats to determine significant trends;


5. Create diverse teams of parent committees that contribute to NICU culture;


6. Use qualified interpreters when caring for families that do not speak English;


7. Provide information in multiple languages whenever possible;


8. Consider discharge requirements and available resources for a successful transition home; and


9. Be an advocate for racial awareness and equality in your hospital and community.


We hope you will consider these recommendations and initiate the conversation in your units. See for the entire position statement. Additional education resources can be located at


At NANN's annual conference in October 2020, Dr Jenne Johns, a national health equity thought leader, discussed her experience as the mother of a micropreemie in the NICU. Her experience challenges us to consider the role we should play in eliminating health disparities. Dr Johns' recommendations provide a path for delivery of high-quality and equitable care to all families, regardless of race, language, or socioeconomic status. Dr Johns' presentation would provide you a peek inside the world of what it is like to have a Black infant in the NICU, and we believe it will inspire you to be a better version of yourself. You can locate Dr Johns' conference presentation for access to the session. This presentation is freely available to all through this link even if you did not register or attend the conference. Please share widely; this message is important to delivery of excellent care.


In this issue of Advances in Neonatal Care for 2021, we continue this discussion with an article, titled "Becoming an Anti-racist Neonatal Community." We hope you will take the time to carefully read this work and commit yourself to opening up and learning about the history of how we got to this point in neonatal care and what we can do as a neonatal community to move forward.


Remaining in place is not an option if we are to provide the best neonatal care possible to all of our infants. However, moving forward will require hard work from everyone.




-Debra Brandon, PhD, RN, CCNS, FAAN


Co-Editor; Advances in Neonatal Care


-Jacqueline M. McGrath, PhD, RN, FNAP, FAAN


Co-Editor; Advances in Neonatal Care




1. Wallace M, Crear-Perry J, Richardson L, Tarver M, Theall K. Separate and unequal: structural racism and infant mortality in the US. Health Place. 2017;45:140-144. [Context Link]


2. Beck AF, Edwards EM, Horbar JD, Howell EA, McCormick MC, Pursley DM. The color of health: how racism, segregation, and inequality affect the health and well-being of preterm infants and their families. Pediatr Res. 2020;87(2):227-234. [Context Link]


3. Matoba N, Collins JW Jr. Racial disparity in infant mortality. Semin Perinatol. 2017;41(6):354-359. [Context Link]


4. Ely DM, Driscoll AK. Infant mortality in the United States, 2018: data from the period linked birth/infant death file. Natl Vital Stat Rep. 2020;69(7):1-18.; Accessed November 13, 2020. [Context Link]


5. Smith IZ, Bentley-Edwards KL, El-Amin S, Darity W. Fighting at birth: eradicating the Black-White infant mortality gap. Accessed November 13, 2020. [Context Link]