Objective To identify and describe characteristics of neonatal and pediatric intensive care in Rio de Janeiro State, correlating with population demands and with the situation 10 years ago.

Methods All neonatal and pediatric Intensive Care Units were visited (Oct 2006–Nov 2007), identifying the need of beds for the state, interior and metropolitan areas. Comparisons between offer and demand were made and with similar data collected in 1997.

Results We identified 94 units totaling 1,152 beds (80 and 1,080 in 1997): 53% public and 47% private (57% and 43% in 1997); 64% in neonatal, 21% in pediatric and 15% in mixed units, totaling 851 neonatal beds (791 in 1997). Most units were in Rio de Janeiro City metropolitan area (77%), with 84% of beds for 74% of children population (89% and 74% in 1997). In the interior area there were 22 units (23%) and 190 beds (16%) for 26% of children population (8 units [11%] and 79 beds [7%] for 26% of children in 1997). The estimated total need of beds is 1,130 (900 neonatal and 230 pediatric). Only 25% of the population have access to private care (47% of the beds), against 75% dependent on public care, for an offer of only 53%.

Conclusion Although access has generally improved, mainly in the interior of the state, there is still no equity in the distribution and accessibility to the available beds, with lack in public, excess in private sectors, and a great concentration in the metropolitan area.