348 - Social and Structural Disparities in Family Presence and Engagement in the NICU

Publication Number: 348.6746

Neha Anand, Boston University School of Medicine, Boston, MA, United States; Nikita S. Kalluri, University of Massachusetts Medical School, Boston, MA, United States; Erika G. Cordova-Ramos, Boston University School of Medicine, Wellesley, MA, United States; Aviel Peaceman, Boston University School of Medicine, Needham, MA, United States; Molly Fraust-Wylie, Beth Israel Deaconess Medical Center, Boston, MA, United States; Zuzanna Kubicka, Boston Children's Hospital, Boston, MA, United States; Margaret Parker, UMass Memorial Children's Medical Center, Worchester, MA, United States

Background: Family engagement in the neonatal intensive care unit (NICU) is associated with well-being of both preterm infants and their caregivers. Previous studies show that caregivers from racial and ethnic minority groups and those who prefer a language other than English are less likely to be present in the NICU. However, the relationship between social vulnerability and family engagement in the NICU is poorly understood.

Objective: We evaluated associations between (1) sociodemographic factors (maternal race and ethnicity, insurance, and language), and (2) the Social Vulnerability Index (SVI), a composite measure of social vulnerability, with NICU family presence and engagement, measured through skin-to-skin care and receipt of breast milk.

Design/Methods: We utilized data from maternal-infant dyads across six NICUs in the Massachusetts Quality Improvement Family Engagement Collaborative (2021-2022). Maternal race and ethnicity, preferred language and insurance were abstracted from medical records. SVI data was linked via maternal zip code. We categorized families by SVI ≥90th percentile (most vulnerable) versus SVI < 90th percentile. Data were collected on specified chart audit days (days 1-8, 21-28 and/or the final 7 days before discharge). Family presence was defined as ≥90% presence on audit days. Family engagement was measured by i) skin-to-skin care ≥50% days when a family member was present and ii) any or exclusive receipt of breast milk at day 7 of life and 24-hours pre-discharge. Mixed-effects logistic regression accounted for clustering by hospital and multiple gestation, and adjusted for maternal age, gestational age, and birth weight.

Results: We included 450 mother-infant dyads (Table 1) with a median gestational age of 33 weeks (IQR [32, 35]). Non-Hispanic Black mothers had lower odds of parental presence (aOR 0.29 [0.11-0.74]) compared to non-Hispanic White mothers. Infants whose mothers had public insurance had lower odds of receiving any (aOR 0.4 [0.23-0.77]) or exclusive (aOR 0.53 [0.30-0.96]) breast milk at discharge compared to those with private insurance. Mothers with SVI ≥90th percentile had lower odds of exclusive receipt of breast milk before discharge (aOR 0.37 [0.15-0.90]) than those with SVI < 90th percentile.

Conclusion(s): In this multi-site Massachusetts cohort, infants in the NICU with non-Hispanic Black mothers had lower rates of parental presence and infants whose mothers had public insurance and lived in highly socially vulnerable communities had lower receipt of breast milk. These findings underscore the need for targeted interventions to improve equitable family engagement.

Table 1. Maternal and Infant Characteristics and Family Presence and Engagement Outcomes


Table 2. Mixed-Effects Logistic Regression of Family Presence and Engagement, Sociodemographic Factors, and Total Social Vulnerability Index (SVI)