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

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.

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

a White represents states without a Level I policy (N = 26); light gray represents states with a Level I policy but not consistent with all Level I requirements in the 2012 AAP Policy (N = 3); and dark gray represents states with a Level I policy and consistent with the 2012 AAP Policy criteria (N = 21). b White represents states without a Level II policy (N = 25); light gray represents states with a Level II policy but not consistent with all Level II requirements in the 2012 AAP Policy (N = 5); and dark gray represents states with a Level II policy and consistent with the 2012 AAP Policy criteria (N = 20). c White represents states without a Level III policy (N = 25); light gray represents states with a Level III policy but not consistent with all Level III requirements in the 2012 AAP Policy (N = 11); and dark gray represents states with a Level III policy and consistent with the 2012 AAP Policy criteria (N = 14). d White represents states without a Level IV policy (N = 28); light gray represents states with a Level IV policy but not consistent with all Level IV requirements in the 2012 AAP Policy (N = 10); and dark gray represents states with a Level IV policy and consistent with the 2012 AAP Policy criteria (N = 12).