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 早产的负担(VPT，妊娠不到32周，包括极早产或28周) 在美国，黑人(非西班牙裔黑人)母亲生育的比例不成比例，她们的年龄在2.2-2.6岁之间 非黑人母亲分娩VPT婴儿的可能性是非黑人母亲的两倍，所有VPT婴儿中有31%是黑人出生的 母亲们。这种差异被放大了，因为黑人VPT婴儿接受母亲VPT的可能性显著降低 从出生到新生儿重症监护病房(NICU)出院的自乳(妈妈)喂养比非黑人婴儿要好， 它排除了当局建议的前6个月的独家母乳喂养，并增加了 VPT出生带来的终生负担。即使VPT婴儿的黑人母亲按费率开始提供母亲 与非黑人母亲类似，并有类似的目标，以维持母亲的供应直到NICU出院 在NICU出院的母亲喂养方面存在显著差异。只有母亲才能缓解孩子们之间的差距 母亲在NICU出院为VPT婴儿喂奶，这种母性行为涉及坚持两个- 部分方案，包括在整个NICU住院期间持续使用吸乳器(每天6-8次) (平均为73天)，并将在家中抽吸的母亲运送到NICU喂养婴儿。 “减少极低出生体重儿接受母乳的差异”(ReDiMOM)是一项 一项随机对照试验，测试旨在抵消自付和 机会成本由VPT婴儿的母亲承担，由NICU支付。干预捆绑包包括 三个组成部分：免费医疗级电动吸奶器，接送妈妈，支付机会成本 与目前的护理标准相比。这份多元化副刊将提供职业发展、指导 以及对斯蒂芬妮·德瓦恩-约翰逊博士的培训，这将加速她的职业轨迹，成为一名 独立研究人员。Devane-Johnson博士的培训目标是：(1)获得关于母亲的知识 在NICU人群中提供服务；(2)掌握将定性研究方法纳入以下领域的专门知识 一项随机对照试验中的黑人NICU母亲及其母系家长；(3)在设计中获得知识， 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 在弱势群体中使用方法；和(4)获得必要的领导技能 以首席研究员的身份进行多学科研究。研究的目的是：(1)确定 经济干预捆绑包的具体组成部分，它们是MOM规定的障碍或促进者 通过NICU出院的VPT婴儿及其母亲的黑人母亲和(2)确定对 黑人母亲和她们的母系家长对新生儿重症监护病房中VPT婴儿的母亲提供情况。所获得的知识 在本多样性补充资料中将提供有关干预组件如何工作的信息，确定 最基本的组成部分，并指导对干预措施的改进，以便扩大和更广泛地传播。

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.