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: 9979609
• 负责人: TRICIA J. JOHNSON
• 金额: $ 66.14万
• 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/9979609
• 关键词: Address; Adherence; Adopted; Adoption; Affect; African American; Asians; Behavior; Benchmarking; Birth; Birth Weight; Bronchopulmonary Dysplasia; Child; Cost Analysis; Cost Effectiveness Analysis; Data; Deposition; Dose; Economics; Effectiveness of Interventions; Employee; Equipment; Family; Funding; Goals; Health; Hispanics; Home environment; Hospitalization; Hospitals; Hour; Household Heads; Human Milk; Incentives; Infant; Infant formula; Inferior; Infrastructure; International; Intervention; Lactation; Life; Low Birth Weight Infant; Low income; Maternal Behavior; Measures; Mediating; Milk; Morbidity - disease rate; Mothers; Native Americans; Necrotizing Enterocolitis; Neonatal Intensive Care Units; Neurodevelopmental Problem; Not Hispanic or Latino; Outcome; Population; Poverty; Pump; Quality Indicator; Randomized; Randomized Clinical Trials; Randomized Controlled Trials; Regimen; Research; Risk; Risk Reduction; Sepsis; Testing; Time; Training; Transportation; United States National Institutes of Health; Very Low Birth Weight Infant; Work; authority; base; breast pump; comparative cost effectiveness; control trial; cost; cost effectiveness; disparity reduction; economic evaluation; emotional distress; feeding; hospital readmission; improved; infant outcome; innovation; late onset sepsis; maternal outcome; milk volume; novel; opportunity cost; pasteurization; payment; primary outcome; response; secondary outcome; standard of care

Project Summary In the US, the burden of very low birth weight (VLBW; <1500 g) birth is borne disproportionately by black (non-Hispanic black/African American) mothers who are 2.2-2.6 times more likely than nonblack mothers to deliver VLBW infants, with 31% of all VLBW infants born to black mothers. This disparity is amplified because black VLBW 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 VLBW birth. In addition, VLBW infants are susceptible to potentially preventable morbidities including late onset sepsis, necrotizing enterocolitis, bronchopulmonary dysplasia and long-term neurodevelopmental problems, which all increase risks of rehospitalization. A dose-response relationship exists between the amount of MOM feedings and a reduction in the risk of these morbidities and their associated costs, with the greatest risk reduction for all four morbidities afforded by high-dose MOM through to NICU discharge. Even though black mothers of VLBW 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 VLBW infant, and this maternal behavior involves adhering to a two-part regimen: 1) sustaining breast pump use (6-8 times/day) for the entire NICU hospitalization (average = 73 days), and 2) transporting the MOM that is pumped in the home to the NICU for infant feedings. These behaviors are associated with out-of-pocket and opportunity costs that are borne by mothers, unlike inferior feeding alternatives such as donor human milk and formula, which are paid for by NICUs. This randomized control trial will test an intervention (NICU acquires MOM) developed to facilitate maternal adherence to this two-part regimen by offsetting the aforementioned costs that serve as barriers to sustaining MOM feedings: a) free hospital-grade electric breast pump, b) pickup of MOM, and c) payment for opportunity costs compared to current standard of care (mother provides MOM). The primary outcome will be receipt of MOM at NICU discharge, with secondary outcomes of volume of MOM pumped and total duration of pumping, infant’s receipt of any MOM feedings, duration of MOM feedings, and cumulative dose of MOM received at NICU discharge. Cost analyses will be performed to: 1) describe and compare the cost of the NICU acquiring MOM versus NICU acquiring donor human milk if MOM is not available; and 2) compare the cost effectiveness of NICU acquiring MOM versus mother providing MOM. This innovative trial will determine the effectiveness of the intervention in reducing the disparity in MOM feedings and provide an economic analysis of the interventions, yielding critical data impacting generalizability and likelihood of implementation of results.

项目摘要 在美国，出生体重（VLBW; <1500 g）的出生负担是由BYE不偏见的 黑人（非西班牙裔黑人/非裔美国人）母亲的年龄比母亲的可能性高2.2-2.6倍 为了提供VLBW婴儿，其中31％的VLBW婴儿出生于黑人母亲。 因为黑人VLBW婴儿从 出生直到新生儿重症监护病房（NICU）出院，而不是非黑人婴儿，这排除了独家妈妈 当局建议的前6个月的喂养，并增加了VLBW终身负担 出生。 败血症，坏死性小肠结肠炎，支气管肺发育不良和长期神经发育问题， 这全都增加了重新住院的风险。 喂养和降低这些病因及其相关成本的风险，风险最大 大剂量妈妈为NICU出院提供的所有人减少了所有人的病毒。 即使是坚强的VLBW婴儿的黑人母亲，以类似于非黑妈妈的价格， 并有类似的目标来维持妈妈的供应到NICU NICU出院时的妈妈喂养。 VLBW婴儿的出院，以及遵守两部分方案的母性行为：1） 在整个NICU住院（平均= 73天）中维持吸气泵的使用（每天6-8次），2） 将妈妈运送到NICU的家中，以进行婴儿喂养 与劣等喂养不同 NICUS支付的供体牛奶和配方等替代品。 将测试开发的干预措施（NICU获取妈妈），以促进孕产妇对这一两部分 通过抵消上述成本来维持妈妈喂养的障碍来通过方案：a）免费 医院级电气泵 当前的护理标准（母亲提供妈妈）。 出院，妈妈抽水和抽水总持续时间的次要结果，婴儿的接收 在任何妈妈的喂养，妈妈喂养的持续时间以及在NICU出院时收到的妈妈的累积剂量。 成本分析将进行：1）描述并比较NICU获取妈妈与 如果妈妈不可用 妈妈与母亲提供妈妈。 干预降低妈妈喂养的差异并对国际的经济分析， 产生关键的数据，影响结果的普遍性和可能性的可能性。