TOPLINE:

Rural areas in the US saw a net loss of 22 birth hospitals offering higher-level neonatal care from 2010 to 2022, whereas urban areas experienced a net gain of 31. In 2022, less than 20% of rural hospitals offered higher-level neonatal care, whereas 74.4% of urban hospitals provided such care.

METHODOLOGY:

• Researchers conducted a retrospective cohort study to examine changes in the availability of higher-level neonatal care at US hospitals with childbirth services from 2010 to 2022.
• Hospitals were classified as having higher-level care if they had neonatal intensive care or intermediate care beds.
• Data sources included American Hospital Association surveys and files from the Centers for Medicare & Medicaid Services.
• Hospital rurality was determined using Office of Management and Budget definitions, distinguishing urban and rural areas.

TAKEAWAY:

• A total of 3257 birth hospitals were included, comprising 1149 rural and 2108 urban hospitals. In 2010, 160 rural hospitals and 1281 urban hospitals provided higher-level neonatal care.
• Between 2010 and 2022, 48 rural and 208 urban hospitals gained higher-level neonatal care, whereas 70 rural and 177 urban hospitals lost such care.
• Rural areas experienced a net loss of 22 hospitals with higher-level neonatal care, whereas urban areas saw a net gain of 31 hospitals.
• In 2010, 14.1% of rural birth hospitals had higher-level neonatal care, which increased slightly but not significantly to 16.9% in 2022. In contrast, urban hospitals saw a significant rise from 64.2% in 2010 to 74.4% in 2022 (P = .01).

IN PRACTICE:

“Rural-urban differences in higher-level neonatal care availability may contribute to the survival gap for rural infants,” the authors of the study wrote.

SOURCE:

The study was led by Katy B. Kozhimannil, PhD, MPA, Division of Health Policy and Management, University of Minnesota, Minneapolis. It was published online on February 12, 2026, as a research letter in JAMA Network Open.

LIMITATIONS:

The study relied on self-reported hospital data, which may not accurately reflect neonatal bed usage. The number of hospitals decreased over time, particularly in rural areas, owing to the closure of hospitals and obstetric units. Patient-level data were lacking, thereby affecting the analysis of patient outcomes.

DISCLOSURES:

The study was supported by grants from the Federal Office of Rural Health Policy, Health Resources and Services Administration, US Department of Health and Human Services, the Eunice Kennedy Shriver National Institute of Child Health and Human Development, and the National Center for Advancing Translational Sciences, National Institutes of Health. Two authors reported receiving grants outside the submitted work, and one of them reported receiving personal fees from the University of Minnesota during the conduct of the study.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.