Equity for Parent Presence and Participation in Caregiving in the NICU

PROJECT SUMMARY/ABSTRACT While some barriers and facilitators to parent presence and participation (PPP) in the neonatal intensive care unit (NICU) have been identified, comprehensive descriptions of factors influencing PPP and changes in these factors over time are lacking. Moreover, race- and socioeconomic-based disparities in PPP have been reported,

but the underlying causes of these disparities are unknown. To increase health equity for preterm infants and their parents, the underlying factors influencing disparities in PPP must be identified. PPP is critical to improving clinical outcomes and neurodevelopment for preterm infants. The purpose of the proposed study is

to comprehensively determine barriers and facilitators affecting PPP in the NICU and effects of PPP on infant outcomes. Using a non-experimental, longitudinal design, the following specific aims and subaims will be accomplished: (Aim 1) determine barriers and facilitators affecting PPP and changes in barriers and facilitators

over time; (Subaim 1) predict barriers and facilitators of PPP based on sociodemographic characteristics; (Aim 2) determine the effect of PPP on infant clinical outcomes and neurodevelopment; (Subaim 2) determine the mediation effect of parent-infant responsiveness on the relationship between PPP and infant clinical outcomes

and neurodevelopment; (Aim 3) determine the moderation effect of PPP on the relationship between infant stress exposure and infant clinical outcomes and neurodevelopment. Parents with an infant born less than 32 weeks gestational age will be enrolled. Parents will complete surveys throughout their infant’s hospitalization

to identify barriers and facilitators influencing PPP and to quantify their experiences of discrimination and parent-staff engagement in the NICU. PPP will be quantified by parent-report, electronic health record documentation, and NICU visitation logs. Infant clinical outcomes, including length of NICU stay and

achievement of oral feeding competence, will be measured throughout hospitalization and at discharge. Neurodevelopment will be assessed at 3-months corrected age using the Test of Infant Motor Performance and 12-months corrected age using the Bayley Scales of Infant and Toddler Development, 4th Edition. Parent-infant

responsiveness at discharge and 3-months corrected age will be determined as will the moderating effect of PPP on infant stress exposure throughout hospitalization. The study focuses on modifiable factors that may disparately affect parents from racially underrepresented groups or those lacking financial and social

resources. By also considering demographic characteristics that may contribute to disparities, the study will provide data to support the development of NICU interventions to equitably promote PPP, thus improving outcomes for preterm infants and their families. This proposal addresses the research priority area of the

NICHD’s Pregnancy and Perinatology Branch to advance the science of preterm birth and its cons equences while incorporating the NICHD’s aspirational goal to enhance the healthy development of preterm infants and cross-cutting theme of addressing health disparities.