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）的燃烧的出生不成比例 黑人（非西班牙裔黑人/非裔美国人）母亲，是非黑母亲的2.2-2.6倍 提供VLBW婴儿，其中有31％的VLBW婴儿出生于黑人母亲。这种差异是放大器 因为黑色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 当局建议使用的前6个月的喂养，并增加了VLBW的终身燃烧 出生。此外，VLBW婴儿容易受到可能预防的病因（包括延迟发作）的影响 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。妈妈的数量之间存在剂量反应关系 喂养和降低这些病因及其相关成本的风险，风险最大 高剂量妈妈通过NICU出院提供的所有四种病毒率的减少。 即使VLBW婴儿的黑人母亲以类似于非黑母亲的价格发起妈妈的准备 并有类似的目标来维持妈妈的规定到NICU出院，这有很大的差距 NICU出院时的妈妈喂养。只有母亲才能减轻NICU妈妈喂养的差异 VLBW婴儿的出院，这种母校行为涉及遵守两部分的疗程：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） 运送在NICU的家中抽出婴儿喂养的妈妈。这些行为是 与母亲所生的自付费和机会成本相关，与较低的喂养不同 NICUS支付的替代品，例如捐赠人牛奶和配方奶。这项随机对照试验 将测试开发的干预措施（NICU获得妈妈），以促进这两部分 通过抵消为维持妈妈喂养的障碍的理由成本而进行的方案：a）免费 医院级电动泵，b）妈妈的接送，c）与 当前的护理标准（母亲提供妈妈）。主要结果将是在NICU接收妈妈 出院，妈妈抽水和抽水总持续时间的次要结果，婴儿的收据 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）描述和比较NICU获取妈妈与 如果妈妈不可用的话，NICU就可以获取捐赠人牛奶； 2）比较NICU的成本效益 收购妈妈与母亲提供妈妈。这项创新的试验将决定 干预措施减少妈妈喂养的差异，并对干预措施进行经济分析， 产生关键的数据，影响概括性和实施结果的可能性。