Reducing Disparity in Receipt of Mother’s Own Milk in Very Low Birth Weight Infants: An Economic Intervention to Improve Adherence to Sustained Maternal Breast Pump Use

减少极低出生体重婴儿接受母乳的差异:提高母亲持续使用吸奶器依从性的经济干预措施

基本信息

  • 批准号:
    10542345
  • 负责人:
  • 金额:
    $ 62.1万
  • 依托单位:
  • 依托单位国家:
    美国
  • 项目类别:
  • 财政年份:
    2020
  • 资助国家:
    美国
  • 起止时间:
    2020-04-18 至 2024-12-31
  • 项目状态:
    已结题

项目摘要

Project Summary In the US, the burden of very low birth weight (VLBW; <1500 g) birth is borne disproportionately by black (non-Hispanic black/African American) mothers who are 2.2-2.6 times more likely than nonblack mothers to deliver VLBW infants, with 31% of all VLBW infants born to black mothers. This disparity is amplified because black VLBW infants are significantly less likely to receive mother’s own milk (MOM) feedings from birth until neonatal intensive care unit (NICU) discharge than nonblack infants, which precludes exclusive MOM feedings for the first 6 months of life as recommended by authorities and adds to the lifelong burden of VLBW birth. In addition, VLBW infants are susceptible to potentially preventable morbidities including late onset sepsis, necrotizing enterocolitis, bronchopulmonary dysplasia and long-term neurodevelopmental problems, which all increase risks of rehospitalization. A dose-response relationship exists between the amount of MOM feedings and a reduction in the risk of these morbidities and their associated costs, with the greatest risk reduction for all four morbidities afforded by high-dose MOM through to NICU discharge. Even though black mothers of VLBW infants initiate MOM provision at rates similar to nonblack mothers and have similar goals to sustain MOM provision through to NICU discharge, there is a significant disparity in MOM feedings at NICU discharge. Only the mother can mitigate the disparity in MOM feedings at NICU discharge for the VLBW infant, and this maternal behavior involves adhering to a two-part regimen: 1) sustaining breast pump use (6-8 times/day) for the entire NICU hospitalization (average = 73 days), and 2) transporting the MOM that is pumped in the home to the NICU for infant feedings. These behaviors are associated with out-of-pocket and opportunity costs that are borne by mothers, unlike inferior feeding alternatives such as donor human milk and formula, which are paid for by NICUs. This randomized control trial will test an intervention (NICU acquires MOM) developed to facilitate maternal adherence to this two-part regimen by offsetting the aforementioned costs that serve as barriers to sustaining MOM feedings: a) free hospital-grade electric breast pump, b) pickup of MOM, and c) payment for opportunity costs compared to current standard of care (mother provides MOM). The primary outcome will be receipt of MOM at NICU discharge, with secondary outcomes of volume of MOM pumped and total duration of pumping, infant’s receipt of any MOM feedings, duration of MOM feedings, and cumulative dose of MOM received at NICU discharge. Cost analyses will be performed to: 1) describe and compare the cost of the NICU acquiring MOM versus NICU acquiring donor human milk if MOM is not available; and 2) compare the cost effectiveness of NICU acquiring MOM versus mother providing MOM. This innovative trial will determine the effectiveness of the intervention in reducing the disparity in MOM feedings and provide an economic analysis of the interventions, yielding critical data impacting generalizability and likelihood of implementation of results.
项目摘要 在美国,极低出生体重儿(VLBW;&lt;1500 g)的负担由 黑人(非西班牙裔黑人/非裔美国人)母亲的风险是非黑人母亲的2.2-2.6倍 接生极低出生体重儿,其中31%的极低出生体重儿为黑人母亲所生。这种差距被放大了 因为黑人极低出生体重儿接受母乳喂养的可能性显著降低。 直到新生儿重症监护病房(NICU)出院的婴儿比非黑人婴儿更多,这排除了唯一的母亲 当局建议的生命头6个月的喂养,增加了极低出生体重儿的终生负担 出生。此外,极低出生体重儿易患潜在的可预防的疾病,包括晚发。 脓毒症,坏死性小肠结肠炎,支气管肺发育不良和长期的神经发育问题, 所有这些都会增加再次住院的风险。在MOM的量之间存在剂量-反应关系 喂养和减少这些疾病的风险及其相关成本,风险最大 从大剂量MOM到NICU出院的所有四种发病率的降低。 即使极低出生体重儿的黑人母亲开始提供母亲的比率与非黑人母亲相似 和有相似的目标来维持MOM供应直到NICU出院,在 妈妈在NICU出院时喂奶。只有母亲才能缓解NICU中母亲喂养的差异 极低出生体重儿的出院,这一母性行为涉及坚持两部分方案:1) 在整个NICU住院期间持续使用吸奶器(每天6-8次)(平均73天),2) 将在家中抽出的母亲运送到NICU进行婴儿喂养。这些行为是 与劣质喂养不同,与母亲自掏腰包和机会成本相关 其他替代品,如捐献的母乳和配方奶粉,由NICU支付费用。这项随机对照试验 将测试为促进母亲对这两部分的坚持而开发的干预措施(NICU获得MOM) 通过抵消作为维持母亲喂养的障碍的上述成本来养生:a)免费 医院级电动吸乳器,b)母亲代孕,c)支付机会成本,与 目前的护理标准(母亲提供母亲)。主要结果将是在NICU接受MOM 出院,次要结果为母婴输液量和总输液时间,婴儿收据 在NICU出院时,任何母亲喂养的次数、母亲喂养的持续时间和母亲的累积剂量。 将执行成本分析以:1)描述和比较NICU获取MOM的成本与 NICU在没有母亲的情况下获取供者母乳;2)比较NICU的成本效益 获得母亲与母亲提供母亲。这项创新的试验将决定 减少母亲喂养差距的干预措施,并提供干预措施的经济分析, 产生影响成果可推广性和实施可能性的关键数据。

项目成果

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TRICIA J. JOHNSON其他文献

TRICIA J. JOHNSON的其他文献

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{{ truncateString('TRICIA J. JOHNSON', 18)}}的其他基金

Early Childhood Neurodevelopmental, Economic and Nutritional Outcomes among Former Very Low Birth Weight Infants from the Reducing Disparity in Mother's Own Milk (ReDiMOM) Trial
减少母乳差异 (ReDiMOM) 试验对原极低出生体重婴儿的早期儿童神经发育、经济和营养结果
  • 批准号:
    10528759
  • 财政年份:
    2022
  • 资助金额:
    $ 62.1万
  • 项目类别:
Early Childhood Neurodevelopmental, Economic and Nutritional Outcomes among Former Very Low Birth Weight Infants from the Reducing Disparity in Mother's Own Milk (ReDiMOM) Trial
减少母乳差异 (ReDiMOM) 试验对原极低出生体重婴儿的早期儿童神经发育、经济和营养结果
  • 批准号:
    10705312
  • 财政年份:
    2022
  • 资助金额:
    $ 62.1万
  • 项目类别:
Reducing Disparity in Receipt of Mother's Own Milk in Very Low Birth Weight Infants: An Economic Intervention to Improve Adherence to Sustained Maternal Breast Pump Use
减少极低出生体重婴儿接受母乳的差异:提高母亲持续使用吸奶器依从性的经济干预措施
  • 批准号:
    10547512
  • 财政年份:
    2020
  • 资助金额:
    $ 62.1万
  • 项目类别:
Reducing Disparity in Receipt of Mother’s Own Milk in Very Low Birth Weight Infants: An Economic Intervention to Improve Adherence to Sustained Maternal Breast Pump Use
减少极低出生体重婴儿接受母乳的差异:提高母亲持续使用吸奶器依从性的经济干预措施
  • 批准号:
    9979609
  • 财政年份:
    2020
  • 资助金额:
    $ 62.1万
  • 项目类别:
Reducing Disparity in Receipt of Mother’s Own Milk in Very Low Birth Weight Infants: An Economic Intervention to Improve Adherence to Sustained Maternal Breast Pump Use
减少极低出生体重婴儿接受母乳的差异:提高母亲持续使用吸奶器依从性的经济干预措施
  • 批准号:
    10312811
  • 财政年份:
    2020
  • 资助金额:
    $ 62.1万
  • 项目类别:
Reducing Disparity in Receipt of Mother’s Own Milk in Very Low Birth Weight Infants: An Economic Intervention to Improve Adherence to Sustained Maternal Breast Pump Use
减少极低出生体重婴儿接受母乳的差异:提高母亲持续使用吸奶器依从性的经济干预措施
  • 批准号:
    10832823
  • 财政年份:
    2020
  • 资助金额:
    $ 62.1万
  • 项目类别:
The Economics of Information in the Health Care Market
医疗保健市场中的信息经济学
  • 批准号:
    6454735
  • 财政年份:
    2002
  • 资助金额:
    $ 62.1万
  • 项目类别:

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