Racial and ethnic disparities in neonatal health outcomes are well-established and enduring. Non-Hispanic Black (herein, referred to as Black) infants are twice as likely as non-Hispanic White infants (herein, referred to as White) to be born prematurely (<37 weeks gestation)1 and are more likely to die before leaving the hospital.2,3 Black premature infants in the NICU experience higher incidence of some major comorbidities, including necrotizing enterocolitis (NEC), early onset sepsis, retinopathy of prematurity (ROP), and severe intraventricular hemorrhage.3, 4, 5, 6 Disparities in NEC and ROP are also seen in Hispanic/Latinx (herein, referred to as Hispanic) infants.3,6,7 As of 2019, rates of mortality before one year of age were 2.4 and 1.1 times those of White infants for Black and Hispanic infants, respectively.8

Neonatal health professionals are tasked with “following through” for all patients, beyond their time in the NICU, particularly for minoritized families.9 However, literature linking racial and ethnic disparities measured in the NICU to outcomes in later childhood is scant. As overall rates of in-hospital mortality have declined for premature infants,2 more infants leave the NICU to enter the same environmental conditions that led to an increased risk of preterm birth. Unlike their term counterparts, NICU graduates are more likely to be medically complex,10 and so arrive home already at a disadvantage. The early postnatal period is critical for future development, so barriers to care compounded on medical vulnerability may worsen existing health inequities or create new ones. However, most studies of post-discharge outcomes fail to capture the range of health trajectories.11

Therefore, we propose a multi-dimensional conceptualization of infant health, which we refer to as ‘thriving’, in line with the WHO definition of health.12 We present a model (Figure 1) to represent our evolved understanding of the processes that shape a patient's ability to thrive.13, 14, 15, 16 We then review the existing literature on racial and ethnic disparities in infant outcomes after NICU discharge across 3 key domains: 1) physical health and growth, 2) development, 3) social and emotional wellbeing (Table 1). We focus our analysis on outcomes for Black and/or Hispanic infants, recognizing that investigation of disparities for other racial and ethnic groups is severely limited and warrants continued evaluation.