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

探讨新生儿转运对黑人早产儿健康的影响以及父母在社会经济和种族不平等的社会决定因素方面面临的心理社会挑战

• 批准号: 10751547
• 负责人: Karen F Warren
• 金额: $ 3.41万
• 依托单位: UNIVERSITY OF SOUTH CAROLINA AT COLUMBIA
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-08-16 至 2024-08-15
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10751547
• 关键词: Address; Admission activity; Affect; Birth; Black race; Caring; Case Study; Characteristics; Child Rearing; Clinical; Community Hospitals; Country; Data; Data Collection; Depressed mood; Discipline of obstetrics; Discrimination; Education; Family; Financial Hardship; Fostering; Foundations; Future; Gestational Age; Goals; Grant; Health; Health Disparities Research; Health Promotion; Health Services Accessibility; Healthcare; Home; Hospitalization; Hospitals; Human Resources; Improve Access; Individual; Infant; Infant Health; Insurance; Intervention Studies; Low Birth Weight Infant; Medical; Mental Depression; Mental Health; Methods; Modeling; Morbidity - disease rate; Mothers; National Institute of Nursing Research; National Institute on Minority Health and Health Disparities; Neonatal; Neonatal Intensive Care Units; Nurses; Outcome; Parents; Personal Satisfaction; Persons; Premature Birth; Premature Infant; Premature Labor; Prenatal care; Prevention; Privatization; Productivity; Publishing; Quality of life; Race; Reduce health disparities; Research; Research Design; Research Methodology; Research Support; Resources; Risk; Scientist; Shapes; Socioeconomic Status; South Carolina; Strategic Planning; Stress; Substance abuse problem; System; Training; United States; Vulnerable Populations; Woman; adverse birth outcomes; biomedical referral center; black women; career; cost; ethnic disparity; experience; extreme prematurity; health care availability; health difference; health disparity; health equity; improved; infant death; infant morbidity/mortality; infant outcome; innovation; minority health; minority health disparity; next generation; novel strategies; peer; premature; prevent; psychosocial; racial disparity; risk mitigation; social determinants; social health determinants; socioeconomics; structural determinants; tertiary care

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

背景：美国（US）是世界上人口最多的十个国家之一。 早产和低出生体重是美国婴儿死亡的第二大原因， 2在2020年，早产单胎的比率几乎是 黑人母亲比白人母亲高65%。3每1000名早产或低出生体重婴儿中， 更多的黑人婴儿比他们的白色同龄人死亡。4健康的社会决定因素（SDOH）可以影响婴儿 结果。不同种族背景和抑郁社会经济地位（SES）的个人最多 缺乏获得保健的机会，往往得不到充分的照顾，5、6 高质量的医院比他们的白色同行，7，8促成早产率较高，其中 组每年有超过70，000名婴儿需要被送往新生儿重症监护室（NICU），以预防 并处理早产引起的并发症。9一旦婴儿被运送， 对父母的挑战，他们的家可能离NICU很远。父母的压力很大， 低社会经济背景可能面临额外的挑战，如经济负担，10更高 抑郁率10，11和接触婴儿的机会有限。了解障碍和心理社会挑战 由于婴儿的运输和新生儿重症监护室住院与社会决定因素的关系， 消除社会经济和种族不平等是减少健康差距和提高生活质量的组成部分 和下一代的幸福。这项拟议的研究支持国家护理研究所 研究的战略计划，以支持旨在预防和促进健康的研究， 健康差距，促进健康公平，并考虑健康的社会决定因素（SDOH），以减轻 12研究目的：目的1：描述每个婴儿的运输轨迹， 包括社区分娩医院的基线特征（规模、护理水平、分娩资源）， 运输特点（方式、距离、人员）和婴儿从出生到到达的健康状况 新生儿重症监护室目的2：描述每个婴儿的纵向临床病程轨迹，包括主要 从入住NICU至36周校正胎龄或出院（以两者中的任一者为准）的发病率 第一）。目标3：审查和描述父母因交通而面临的障碍和心理社会挑战 和NICU住院的婴儿的关系，社会经济和种族的社会决定因素 不平等方法：本研究采用多病例研究设计， 方法的方法来描述的轨迹10个黑人出生的婴儿和他们的家庭从出生，通过 运送到转诊中心，并通过至少6周的NICU住院治疗，进行详细分析 每个案件。意义：不断需要创新的研究方法和新的方法 确定结构性歧视的各个方面及其对健康差距和健康结果的影响。