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Abbreviations:Baby-MONITOR — Baby–Measure of Neonatal Intensive Care Outcomes ResearchVLBW — very low birth weight

The ultimate measure of the quality of any health care system is its ability to rescue the most vulnerable patients in an equitable and fair manner. Perhaps no group is more vulnerable than extremely preterm infants. Despite unprecedented advances in modern neonatal intensive care, extreme prematurity remains a major contributor to infant morbidity and mortality and is a source of substantial fiscal burden on the health care system.^1,2 Relatedly, ongoing advances in perinatal medicine have not benefitted every racial and ethnic group to the same degree. Indeed, racial and ethnic disparity in pediatric health outcomes has remained an intransigent problem in the United States such that regardless of the metric used, children of racial and ethnic minority have poorer outcomes than their white peers. In neonatal medicine, Black infants are 50% more likely to be born preterm and twice as likely to be born very preterm than white infants.^2,3 Beyond disparities in the rates of preterm births, premature infants of racial and ethnic minority have poorer outcomes compared with their premature white peers. For example, in a recent study, Howell et al⁴ found that among New York City hospitals, mortality of very preterm infants was highest for Black (32%) and Hispanic (28.1%) infants compared with white infants (22.5%).

Although disparities in the quality of care provided at NICUs to very low birth weight (VLBW) infants are well documented, and Black infants are often cared for in lower-quality NICUs,^5,6 a standardized method of comparing NICU quality was previously not available. With the development of … 

Address correspondence to Olubukola O. Nafiu, MD, FRCA, MS, Department of Anesthesiology and Pain Medicine, Nationwide Children’s Hospital, 700 Children’s Dr, Columbus, OH 43205. E-mail: olubukola.nafiu@nationwidechildrens.org