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Seven years later: state neonatal risk-appropriate care policy consistency with the 2012 American Academy of Pediatrics Policy

Journal of Perinatology volume 42, pages 595–602 (2022)Cite this article

Subjects

Abstract

Objective

To assess consistency of state neonatal risk-appropriate care policies with the 2012 AAP policy seven years post-publication.

Study design

Systematic, web-based review of all publicly available 2019 state neonatal levels of care policies. Information on infant risk (gestational age, birth weight), technology and equipment capabilities, and availability of specialty staffing used to define neonatal levels of care was extracted for review.

Result

Half of states (50%) had a neonatal risk-appropriate care policy. Of those states, 88% had language consistent with AAP-defined Level I criteria, 80% with Level II, 56% with Level III, and 55% with Level IV. Comparing policies (2014–2019), consistency increased in state policies among all levels of care with the greatest increase among level IV criteria.

Conclusion

States improved consistency of policy language by each level of care, though half of states still lack policy to provide minimum standards of care to the most vulnerable infants.

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Fig. 1: Geographic visualization of states demonstrating consistency with the 2012 AAP Policy criteria by level of care, 2019.

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Acknowledgements

The authors would like to thank Keriann Uesugi and graduate students from the University of Illinois at Chicago for supporting the policy updates for this work. The authors would also like to thank the members of the Committee on Fetus and Newborn of the American Academy of Pediatrics and the Association of State and Territorial Health Officials for feedback during an invited in-person discussion on neonatal levels of care in Atlanta, GA, on July 16, 2019.

Author information

Authors and Affiliations

  1. Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA

    Charlan D. Kroelinger, Ekwutosi M. Okoroh, Carla L. DeSisto & Wanda D. Barfield

  2. Centers for Disease Control and Prevention Foundation, Atlanta, GA, USA

    Marion E. Rice

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  1. Charlan D. Kroelinger
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  4. Carla L. DeSisto
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Contributions

C.D.K. validated all policy data excerpts, reviewed the coding of data, and prepared and edited the whole manuscript. M.E.R. reviewed all original sources of data, extracted data from policies, and created the coding categories for the analysis. E.M.O. validated all policy data excerpts, reviewed the coding of data, and drafted the introduction and methods sections of the paper. C.L.D. reviewed the results section, refined the data tables, and provided editorial review of the manuscript. W.D.B. conceptualized the analysis and manuscript, developed the outline for the manuscript structure, and provided editorial review of the manuscript.

Corresponding author

Correspondence to Charlan D. Kroelinger.

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The authors declare no competing interests.

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Kroelinger, C.D., Rice, M.E., Okoroh, E.M. et al. Seven years later: state neonatal risk-appropriate care policy consistency with the 2012 American Academy of Pediatrics Policy. J Perinatol 42, 595–602 (2022). https://doi.org/10.1038/s41372-021-01146-y

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