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

项目摘要 极早产儿（VPT，小于32周妊娠，包括极早产或<28周）的负担 在美国，黑人（非西班牙裔黑人）母亲的生育率不成比例，她们的生育率为2.2 - 2.6 比非黑人母亲分娩VPT婴儿的可能性高出一倍，31%的VPT婴儿出生于黑人 妈妈们这种差异被放大，因为黑人VPT婴儿明显不太可能接受母亲的 从出生到新生儿重症监护室（NICU）出院的自奶（MOM）喂养次数比非黑人婴儿多， 根据权威机构的建议，在出生后的前6个月内， VPT生育的终身负担。即使VPT婴儿的黑人母亲开始提供婴儿护理， 类似于非黑人母亲，并有类似的目标，以维持婴儿用品，直到新生儿重症监护室出院， 在NICU出院时，母乳喂养存在显著差异。只有母亲才能缩小 在新生儿重症监护室出院时为VPT婴儿提供母乳喂养，这种母亲行为涉及遵守两个- 部分方案，包括在整个NICU住院期间持续使用吸奶器（6 - 8次/天） （平均= 73天），并将在家中泵送的母乳运送到NICU进行婴儿喂养。 "减少极低出生体重儿母乳摄入量的差异"（ReDiplomacy）是一项 一项随机对照试验，旨在测试一种经济干预组合， 机会成本由VPT婴儿的母亲承担，由NICU支付。干预包包括 三个组成部分：免费的医院级电动吸奶器，取奶，以及支付机会成本 与目前的护理标准相比。这种多样性补充将提供职业发展，指导 和培训斯蒂芬妮Devane-Johnson博士，这将加速她的职业生涯轨迹，成为一个 独立研究员。Devane-Johnson博士的培训目标是：（1）获得有关 在NICU人群中提供;（2）获得嵌入定性研究方法的专业知识，重点是 随机对照试验中的黑人NICU母亲及其女家长;（3）获得设计知识， 行为改变技术的实施、评价和道德操守，重点是有条件的现金转移 （4）掌握开展工作所需的领导技能; 以首席研究员的身份进行多学科研究。研究目的：（1）确定 经济干预组合的具体组成部分是提供可持续发展的障碍或促进因素 通过对VPT婴儿的黑人母亲及其家长的NICU出院，以及（2）确定对 黑人母亲和她们的女家长关于在NICU为VPT婴儿提供额外服务的问题。获得的知识 在本多样性补充中，将提供有关干预组件如何工作的信息， 最重要的组成部分，并指导改进干预措施，以扩大规模和更广泛地传播。

Project Summary The burden of very preterm (VPT, less than 32 weeks gestation, inclusive of extremely preterm or <28 weeks) birth in the United States is borne disproportionately by Black (non-Hispanic Black) mothers, who are 2.2-2.6 times more likely than non-Black mothers to deliver VPT infants, with 31% of all VPT infants born to black mothers. This disparity is amplified because black VPT 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 VPT birth. Even though black mothers of VPT 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 VPT infant, and this maternal behavior involves adhering to a two- part regimen that includes sustaining breast pump use (6-8 times/day) for the entire NICU hospitalization (average = 73 days) and transporting the MOM that is pumped in the home to the NICU for infant feedings. “Reducing Disparity in Receipt of Mother’s Own Milk in Very Low Birth Weight Infants” (ReDiMOM) is a randomized controlled trial that tests an economic intervention bundle designed to offset the out-of-pocket and opportunity costs borne by mothers of VPT infants and paid for by NICUs. The intervention bundle includes three components: free hospital-grade electric breast pump, pickup of MOM, and payment for opportunity costs compared to current standard of care. This Diversity Supplement will provide career development, mentorship and training to Dr. Stephanie Devane-Johnson that will accelerate her career trajectory to become an independent researcher. Dr. Devane-Johnson’s training goals are to (1) acquire knowledge about MOM provision in the NICU population; (2) acquire expertise in embedding qualitative research methods focused on Black NICU mothers and their matriarchs within a randomized controlled trial; (3) gain knowledge in the design, implementation, evaluation and ethics of behavior change techniques, with a focus on conditional cash transfer methodologies in vulnerable populations; and (4) acquire leadership skills necessary for the conduct of multidisciplinary research in the capacity of a principal investigator. The research aims are to (1) determine specific components of the economic intervention bundle that are barriers or facilitators to MOM provision through to NICU discharge for Black mothers of VPT infants and their matriarchs and (2) identify perceptions of Black mothers and their matriarchs about MOM provision for VPT infants in the NICU. The knowledge gained in this Diversity Supplement will provide information about how the intervention components work, identify the most essential components, and guide refinements to the intervention for scale up and broader dissemination.