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

项目概要/摘要 早产是儿童死亡和发育障碍的主要原因，花费260亿美元 每年。早产儿健康和发育的一个关键因素是分娩过程中母亲的存在 住院治疗，这有助于母乳喂养，参与皮肤护理，并使母亲能够 受益于出院后婴儿护理实践的培训。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去看望住院的早产儿，积极参与 在典型的早产住院的数周内，接受工作人员的培训。 定期访问新生儿重症监护室（NICU）需要母亲承担重大费用，包括 停车、照顾其他孩子、交通和住宿，以及放弃收入。 此外，新的证据表明，经济压力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， 抑制性控制，这可能进一步阻碍低收入母亲参与新生儿重症监护室。基础上 我们的团队进行了可行性试验，我们建议进行1：1的随机对照试验，以严格测试 在420名有婴儿的低收入母亲中，财政转移与护理标准（对照）的影响 妊娠25-33周，在3个3级NICU（1个城市、1个城市/郊区和1个郊区/农村）。的母亲 干预组每住院周将收到160美元转账，并带有一次性“标签”或脚本信息 这就解释了，转移的目的是让他们探望和照顾住院的婴儿。我们的首要 假设是，财政转移可以使经济困难的家庭访问新生儿重症监护室，减少 财务困境的负面心理影响，增加了与产妇自杀行为相关的 这对早产儿的健康和发育具有积极的作用，并可能降低卫生系统的成本。目标1： 将研究财政转移对初级NICU护理行为的影响-母乳供应， 皮肤对皮肤的护理--以及出院后1-2个月的辅助行为--安全睡眠实践。在Aim中 2，我们将考虑作用机制，包括调解人（NICU探视，心理健康和认知 金融转移与利益博弈行为的关系。我们还将 从质量上探讨母亲对资金转移的看法、资金转移影响的媒介以及其他障碍， 促进产妇分娩。在目标3中，我们将对成本驱动因素（住院时间， 30-日再入院和艾德使用）。这种简单且可扩展的干预具有巨大的改进潜力 通过使重点人群能够在新生儿重症监护期间利用现有的临床支持，实现卫生保健服务的公平获得 住院

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.