Local availability of neonatal intensive care at rural hospitals with childbirth services

Objective To compare hospital- and county-level characteristics of rural US hospitals based on distance to the nearest neonatal intensive care unit (NICU). Study design Cross-sectional analysis using data from a survey conducted March-August 2021 with administrators and maternity unit managers at rural hospitals with childbirth services (N = 89). Results Few hospitals had a locally available NICU (onsite: n = 5, 5.6%; <10 miles: n = 0; 10–29 miles away: n = 5, 5.6%). Most were located ≥30 miles away from the nearest NICU (30–60 miles: n = 29, 32.6%; >60 miles: n = 50, 56.2%). All Critical Access Hospitals and hospitals in noncore (less populated) counties were ≥30 miles from NICUs. Hospitals further from NICUs more often had smaller birth volumes, higher proportions of Medicaid-paid births, fewer beds, and higher county-level proportions of lower income or unemployed residents. Conclusion Most surveyed rural hospitals did not have locally available NICUs, and characteristics of those that did suggest more hospital and community resources.