Exploring the impact of neonatal transport on the health of Black preterm infants and psychosocial challenges faced by parents in relation to social determinants of socioeconomic and racial inequities

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Background: The United States (US) is one of the ten countries in the world with the greatest number of preterm births.1 Prematurity and low birth weight are the second leading causes of infant deaths in the US and the leading cause of short and long-term morbidities.2 In 2020, the rate of preterm single births was almost 65% higher for Black mothers compared to White.3 For every 1000 preterm or low birthweight infants born, 25 more Black infants die than their White peers.4 Social Determinants of Health (SDOH) can affect infant outcomes. Individuals of different racial backgrounds and depressed socioeconomic status (SES) are at most risk for lack of access to health care and often receive inadequate care,5,6 and deliver their infants at lower- quality hospitals than their White counterparts,7,8 contributing to higher rates of preterm birth among these groups. Annually, over 70,000 infants require transport to Neonatal Intensive Care Units (NICUs) to prevent and manage complications due to preterm birth.9 Once an infant is transported, this presents an added challenge to parents, whose home may be of distance from the NICU. Parental stress is high, and families of low socioeconomic backgrounds may face additional challenges such as financial burdens,10 higher depression rates10,11 and limited access to their infant. Understanding the barriers and psychosocial challenges faced by parents due to transport and NICU hospitalization of their infant in relationship to social determinants of socioeconomic and racial inequities is integral to reducing health disparities and improving the quality of life and well-being of the next generation. The proposed research supports the National Institute of Nursing Research’s strategic plan to support studies aimed at prevention and health promotion targeting elimination of health disparities, fostering health equity, and considering social determinants of health (SDOH) to mitigate risks to families of preterm infants.12 Research Aims: Aim 1: Describe each infant’s transport trajectory, including baseline characteristics of the community hospital of birth (size, level of care, birthing resources), transport characteristics (mode, distance, personnel), and infant health from birth to arrival of regional referral neonatal intensive care unit. Aim 2: Describe each infant’s longitudinal clinical course trajectory including major morbidity from admission to the NICU until 36 weeks corrected gestational age or discharge (whichever is first). Aim 3: Examine and describe the barriers and psychosocial challenges faced by parents due to transport and NICU hospitalization of their infant in relationship to social determinants of socioeconomic and racial inequities. Methods: This descriptive, exploratory study will use a multiple-case study design and mixed methods approach to describe the trajectory of 10 Black outborn infants and their families from birth, through transport to a referral center and through a minimum of 6 weeks of NICU hospitalization, for a detailed analysis of each case. Significance: There is an ongoing need for innovative research methods, and new approaches for identifying aspects of structural discrimination and its impact on health disparities and health outcomes.13