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

减少极低出生体重婴儿接受母乳的差异：提高母亲持续使用吸奶器依从性的经济干预措施

• 批准号: 10547512
• 负责人: TRICIA J. JOHNSON
• 金额: $ 5.81万
• 依托单位: RUSH UNIVERSITY MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-04-18 至 2024-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10547512
• 关键词: Acceleration; Address; Adherence; Adopted; Adoption; Affect; African American; Asian; Authorization documentation; Benchmarking; Birth; Birth Weight; Black race; Bronchopulmonary Dysplasia; Child; Cost Effectiveness Analysis; Data; Deposition; Disparity; Donor Exclusions; Dose; Economics; Employee; Equipment; Ethics; Evaluation; Eye; Family; Funding; Goals; Health; Hispanic; Home; Hospitalization; Hospitals; Hour; Household Heads; Human Milk; Infant; Inferior; Infrastructure; Interdisciplinary Study; International; Intervention; Knowledge; Knowledge acquisition; Lactation; Leadership; Life; Low income; Maternal Behavior; Measures; Mediating; Mentorship; Methodology; Milk; Morbidity - disease rate; Mothers; Native Americans; Necrotizing Enterocolitis; Neonatal Intensive Care Units; Neurodevelopmental Problem; Not Hispanic or Latino; Outcome; Parents; Perception; Population; Poverty; Pregnancy; Principal Investigator; Pump; Qualitative Research; Quality Indicator; Randomized, Controlled Trials; Recommendation; Regimen; Research; Research Methodology; Research Personnel; Risk; Sepsis; Techniques; Testing; Training; Transportation; United States; United States National Institutes of Health; Very Low Birth Weight Infant; Vulnerable Populations; Work; authority; behavior change; breast pump; career; career development; comparative cost effectiveness; coping; cost; cost comparison; design; disparity reduction; emotional distress; extreme prematurity; feeding; improved; infant outcome; innovation; late onset sepsis; maternal outcome; milk volume; novel; opportunity cost; pasteurization; payment; primary outcome; randomized, clinical trials; scale up; skills; standard of care

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.

项目摘要 非常早产的燃烧（VPT，妊娠不到32周，包括非常早产或<28周） 在美国的出生是由黑人（非西班牙裔黑人）母亲（2.2-2.6）出生的不成比例的。 与非黑色母亲交付VPT婴儿的可能性更大，而黑色出生的所有VPT婴儿中有31％ 母亲。由于黑人VPT婴儿接受母亲的可能性明显较小，因此这种差异被放大了 从出生到新生儿重症监护室（NICU）出院的牛奶（妈妈）喂养，而不是非店的婴儿， 这排除了当局建议的前6个月的独家妈妈喂养，并补充 到VPT诞生的终生燃烧。即使黑人母亲的VPT婴儿母亲以速率发起妈妈的供应 类似于非黑色母亲，并且有类似的目标，可以维持妈妈的规定到NICU出院，那里 在NICU出院时，妈妈喂养是一个显着差异。只有母亲才能减轻差距 NICU出院时的妈妈喂养为VPT婴儿，这种母校的行为涉及遵守两种 零件方案包括在整个NICU住院 （平均= 73天）并运送在NICU中泵送的妈妈来进行婴儿喂养。 “在非常低的出生体重婴儿中减少母亲自己的牛奶的差异”（redimom）是一个 随机对照试验测试旨在抵消自付费用的经济干预捆绑包 机会成本由VPT婴儿的母亲承担，并由NICUS支付。干预捆绑包包括 三个组件：免费医院电动泵，妈妈的接送和付款机会费用 与当前的护理标准相比。这种多样性补充剂将提供职业发展，Mentalship 并向斯蒂芬妮·德瓦恩·约翰逊（Stephanie Devane-Johnson）博士进行培训，该培训将加速她的职业轨迹 独立研究员。 Devane-Johnson博士的培训目标是（1）获取有关妈妈的知识 NICU人口的准备； （2）获取嵌入定性研究方法的专业知识。 在随机对照试验中，黑人尼古斯母亲及其族长； （3）获得设计知识， 行为改变技术的实施，评估和道德规范，重点是有条件的现金转移 弱势群体的方法； （4）获得进行所必需的领导技能 以首席研究者的身份进行多学科研究。研究目的是（1）确定 经济干预捆绑包的特定组成部分是妈妈条款的障碍或促进者 直到黑人母亲的NICU出院，VPT婴儿及其族长的母亲，（2）确定对 黑人母亲及其族长关于NICU中VPT婴儿的妈妈提供。知识获得了 在这种多样性中，补充将提供有关干预组件如何工作的信息，确定 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的传播。