Effect of support for low-income mothers of preterm infants on parental caregiving in the NICU

项目摘要/摘要 早产是导致儿童死亡和发育障碍的主要原因，造成260亿美元的损失 每年一次。早产儿健康和发育的一个关键因素是产妇在分娩过程中的存在。 住院，这有助于提供母乳，参与皮肤对皮肤的护理，并允许母亲 受益于出院后婴儿护理实践方面的培训。然而，这些好处只有在以下情况下才能实现 母亲们每天能够花几个小时探望她们住院的早产儿，积极参与 在典型的早产住院期间的几周内，护理和接受工作人员的培训。 定期去新生儿重症监护病房(NICU)需要母亲承担巨额费用，包括 除了放弃的收入之外，停车、照看其他孩子、交通和住宿。 此外，新的证据表明，经济压力带来的心理负担可能会恶化心理健康。 结果(包括压力和抑郁)并阻碍认知功能，如注意力、记忆力和 抑制性控制，这可能进一步阻碍低收入母亲参与NICU照料。在基础上建设 由我们团队进行的可行性试验，我们建议进行1：1随机对照试验，以进行严格的检验 财政转移支付对420名低收入怀孕母亲照护(对照)标准的影响 妊娠25-33周在3个三级NICU(1个城市，1个城市/郊区和1个郊区/农村)。世界上的母亲 干预组将获得每周160美元的转账，并附有一次性“标签”或脚本信息 这解释了转移是为了让他们去看望和照顾他们住院的婴儿。我们的初选 假设资金转移可以使经济困难的家庭去NICU就诊，减少 经济困难带来的负面心理影响，增加了母亲的照看行为 积极的早产儿健康和发育，并有可能降低卫生系统的成本。在目标1中，我们 将研究资金转移对初级NICU照料行为的影响--母乳供应和 皮肤对皮肤护理--出院后1-2个月的次级护理行为--安全睡眠实践。在AIM 2、我们将考虑行动机制，包括调解人(NICU探视、心理健康和认知 金融转移与利益照顾行为之间的关系。我们还将 定性地探讨金融转移的母性视角、其影响的调解人以及其他障碍和 母亲照料的促进者。在目标3中，我们将对成本动因(逗留时间、 30天再次入院和ED使用)。这一简单且可扩展的干预措施具有巨大的改进潜力 通过使重点人群能够在NICU期间利用现有的临床支持，实现卫生保健机会的公平 住院治疗。

PROJECT SUMMARY / ABSTRACT Preterm birth is the leading cause of childhood mortality and developmental disabilities and costs $26 billion annually. A critical modifier of preterm infant health and development is maternal presence during the birth hospitalization, which facilitates breast milk provision, participation in skin-to-skin care and allows mothers to benefit from training in post-discharge infant care practices. However, these benefits can only be realized if mothers are able to visit their hospitalized preterm infants for several hours per day, actively engage in caregiving and receive training from staff during the many weeks of a typical preterm birth hospitalization. Regularly visiting a neonatal intensive care unit (NICU) requires mothers to shoulder significant costs, including parking, childcare for other children, transportation, and accommodations, in addition to forgoing income. Moreover, new evidence suggests that the psychological burden of financial strain may worsen mental health outcomes (including stress and depression) and impede cognitive functions such as attention, memory, and inhibitory control, which may further impede low-income mothers’ participation in NICU caregiving. Building on a feasibility trial conducted by our team, we propose to conduct a 1:1 randomized control trial to rigorously test the impact of financial transfers versus standard of care (control) among 420 low-income mothers with infants 25-33 weeks’ gestation in 3 level 3 NICUs (1 urban, 1 urban/suburban and 1 suburban/rural). Mothers in the intervention arm will receive a transfer of $160 per hospital week with a one-time “label” or scripted message that explains that the transfer is intended for them to visit and care for their hospitalized infant. Our primary hypothesis is that financial transfers can enable economically disadvantaged families to visit the NICU, reduce the negative psychological impacts of financial distress, increase maternal caregiving behaviors associated with positive preterm infant health and development and potentially reduce health systems costs. In Aim 1, we will examine the impact of financial transfers on primary NICU caregiving behaviors --breastmilk provision and skin-to-skin care-- and secondary 1-2 month post-discharge caregiving behaviors-- safe sleep practices. In Aim 2, we will consider mechanisms of action, including mediators (NICU visitation, mental health, and cognitive function) of the relationship between financial transfers and caregiving behaviors of interest. We will also qualitatively explore maternal perspectives of financial transfers, mediators of its impact, and other barriers and facilitators to maternal caregiving. In Aim 3, we will conduct exploratory analysis of cost drivers (length of stay, 30-day readmission and ED use). This simple and scalable intervention has tremendous potential to improve equity in health care access by enabling key populations to utilize existing clinical supports during the NICU hospitalization.