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Am J Perinatol
DOI: 10.1055/a-2318-5942
Original Article

Associations between Parental Engagement in the Neonatal Intensive Care Unit and Neighborhood-Level Socioeconomic Status

Lisa S. Wallace 
1   Division of Neonatology, ChristianaCare, Newark, Delaware
,
Ololade Okito
2   Division of Neonatology, Children's National Hospital, Washington, District of Columbia
3   George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
4   Merck & Co., Inc., Rahway, New Jersey
,
Kelsi Mellin
5   Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
,
Lamia Soghier
2   Division of Neonatology, Children's National Hospital, Washington, District of Columbia
3   George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
› Author Affiliations Funding None.
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Abstract

Objective This study aimed to (1) determine the effect of neighborhood-level socioeconomic status (SES), which considers the social and physical environment where a person lives, on parental engagement in the Neonatal Intensive Care Unit (NICU) and (2) compare the relationships between parental engagement and individual versus neighborhood-level measures of SES.

Study Design In this cohort study, parents (n = 45) of premature neonates ≤34 weeks' gestation were assessed at 2 and 6 weeks after birth from December 2017 to October 2019. Neighborhood-level SES was determined using census data per the Association of Maternal and Child Health Programs' methodology, and parents self-reported their education level as an individual-level measure of SES. Data on frequency of engagement in NICU activities, including telephone updates, visitation, providing expressed breastmilk, and participating in kangaroo care, were collected from the electronic medical record. Parent psychosocial factors were assessed using validated surveys. Statistical analysis was performed using Fisher's exact test, t-test, and logistic regression.

Results In multivariate regression analysis, disadvantaged neighborhood-level SES was associated with decreased odds of kangaroo care (OR = 0.16, 95% CI: [0.03–0.89]) and visitation (OR = 0.14, 95% CI: [0.02–0.87]), while lower individual-level SES was not significantly associated with kangaroo care, visiting, calling, or pumping (p > 0.05).

Conclusion Parental engagement was more consistently and significantly associated with neighborhood-level SES than with individual-level SES. Therefore, neighborhood-level SES measures may be more explanatory than individual-level SES measures. Further studies and targeted interventions are needed to address disparities in the frequency of kangaroo care and visitation according to SES.

Key Points

  • Parents from disadvantaged neighborhoods are less likely to do kangaroo care and visit the NICU.

  • Parent engagement was more significantly associated with neighborhood than with parent education.

  • Neighborhood-level SES measures may be more explanatory than individual-level SES measures.

  • Interventions are needed to address SES-related disparities in NICU kangaroo care and visitation.

Keywords

prematurity - breastfeeding - kangaroo care - parent visitation - social determinants of health - neighborhood disadvantage


Publication History

Received: 24 January 2024

Accepted: 02 May 2024

Accepted Manuscript online:
03 May 2024

Article published online:
31 May 2024

© 2024. Thieme. All rights reserved.

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  • References

  • 1 Cho ES, Kim SJ, Kwon MS. et al. The effects of kangaroo care in the neonatal intensive care unit on the physiological functions of preterm infants, maternal-infant attachment, and maternal stress. J Pediatr Nurs 2016; 31 (04) 430-438
    CrossrefPubMedGoogle Scholar
  • 2 Roberts KL, Paynter C, McEwan B. A comparison of kangaroo mother care and conventional cuddling care. Neonatal Netw 2000; 19 (04) 31-35
    CrossrefPubMedGoogle Scholar
  • 3 Gathwala G, Singh B, Balhara B. KMC facilitates mother baby attachment in low birth weight infants. Indian J Pediatr 2008; 75 (01) 43-47
    CrossrefPubMedGoogle Scholar
  • 4 Linde K, Lehnig F, Nagl M, Kersting A. The association between breastfeeding and attachment: a systematic review. Midwifery 2020; 81: 102592
    CrossrefPubMedGoogle Scholar
  • 5 Tessier R, Cristo M, Velez S. et al. Kangaroo mother care and the bonding hypothesis. Pediatrics 1998; 102 (02) e17
    CrossrefPubMedGoogle Scholar
  • 6 Flacking R, Ewald U, Nyqvist KH, Starrin B. Trustful bonds: a key to “becoming a mother” and to reciprocal breastfeeding. Stories of mothers of very preterm infants at a neonatal unit. Soc Sci Med 2006; 62 (01) 70-80
    CrossrefPubMedGoogle Scholar
  • 7 Preyde M, Ardal F. Effectiveness of a parent “buddy” program for mothers of very preterm infants in a neonatal intensive care unit. CMAJ 2003; 168 (08) 969-973
    PubMedGoogle Scholar
  • 8 Greene MM, Rossman B, Patra K, Kratovil A, Khan S, Meier PP. Maternal psychological distress and visitation to the neonatal intensive care unit. Acta Paediatr 2015; 104 (07) e306-e313
    CrossrefPubMedGoogle Scholar
  • 9 Boundy EO, Dastjerdi R, Spiegelman D. et al. Kangaroo mother care and neonatal outcomes: a meta-analysis. Pediatrics 2016; 137 (01) e20152238
    CrossrefPubMedGoogle Scholar
  • 10 Pineda R, Bender J, Hall B, Shabosky L, Annecca A, Smith J. Parent participation in the neonatal intensive care unit: predictors and relationships to neurobehavior and developmental outcomes. Early Hum Dev 2018; 117: 32-38
    CrossrefPubMedGoogle Scholar
  • 11 Latva R, Lehtonen L, Salmelin RK, Tamminen T. Visiting less than every day: a marker for later behavioral problems in Finnish preterm infants. Arch Pediatr Adolesc Med 2004; 158 (12) 1153-1157
    CrossrefPubMedGoogle Scholar
  • 12 Menon G, Williams TC. Human milk for preterm infants: why, what, when and how?. Arch Dis Child Fetal Neonatal Ed 2013; 98 (06) F559-F562
    CrossrefPubMedGoogle Scholar
  • 13 Giacoia GP, Rutledge D, West K. Factors affecting visitation of sick newborns. Clin Pediatr (Phila) 1985; 24 (05) 259-262
    CrossrefPubMedGoogle Scholar
  • 14 Northrup TF, Evans PW, Lillie ML, Tyson JE. A free parking trial to increase visitation and improve extremely low birth weight infant outcomes. J Perinatol 2016; 36 (12) 1112-1115
    CrossrefPubMedGoogle Scholar
  • 15 Hall EM, Shahidullah JD, Lassen SR. Development of postpartum depression interventions for mothers of premature infants: a call to target low-SES NICU families. J Perinatol 2020; 40 (01) 1-9
    CrossrefPubMedGoogle Scholar
  • 16 Li R, Darling N, Maurice E, Barker L, Grummer-Strawn LM. Breastfeeding rates in the United States by characteristics of the child, mother, or family: the 2002 National Immunization Survey. Pediatrics 2005; 115 (01) e31-e37
    CrossrefPubMedGoogle Scholar
  • 17 Brignoni-Pérez E, Scala M, Feldman HM, Marchman VA, Travis KE. Disparities in kangaroo care for premature infants in the neonatal intensive care unit. J Dev Behav Pediatr 2022; 43 (05) e304-e311
    CrossrefPubMedGoogle Scholar
  • 18 Sigurdson K, Morton C, Mitchell B, Profit J. Disparities in NICU quality of care: a qualitative study of family and clinician accounts. J Perinatol 2018; 38 (05) 600-607
    CrossrefPubMedGoogle Scholar
  • 19 Blumenshine P, Egerter S, Barclay CJ, Cubbin C, Braveman PA. Socioeconomic disparities in adverse birth outcomes: a systematic review. Am J Prev Med 2010; 39 (03) 263-272
    CrossrefPubMedGoogle Scholar
  • 20 Galobardes B, Shaw M, Lawlor DA, Lynch JW, Davey Smith G. Indicators of socioeconomic position (part 1). J Epidemiol Community Health 2006; 60 (01) 7-12
    CrossrefPubMedGoogle Scholar
  • 21 Giurgescu C, Misra DP, Sealy-Jefferson S. et al. The impact of neighborhood quality, perceived stress, and social support on depressive symptoms during pregnancy in African American women. Soc Sci Med 2015; 130: 172-180
    CrossrefPubMedGoogle Scholar
  • 22 Yourkavitch J, Kane JB, Miles G. Neighborhood disadvantage and neighborhood affluence: associations with breastfeeding practices in urban areas. Matern Child Health J 2018; 22 (04) 546-555
    CrossrefPubMedGoogle Scholar
  • 23 Sullivan BA, Doshi A, Chernyavskiy P. et al. Neighborhood deprivation and association with neonatal intensive care unit mortality and morbidity for extremely premature infants. JAMA Netw Open 2023; 6 (05) e2311761
    CrossrefPubMedGoogle Scholar
  • 24 Fraiman YS, Stewart JE, Litt JS. Race, language, and neighborhood predict high-risk preterm Infant Follow Up Program participation. J Perinatol 2022; 42 (02) 217-222
    CrossrefPubMedGoogle Scholar
  • 25 Manickam S, Vivier PM, Rogers ML. et al. Neighborhood inequality and emergency department use in neonatal intensive care unit graduates. J Pediatr 2020; 226: 294-298.e1
    CrossrefPubMedGoogle Scholar
  • 26 Deschamps J, Boucekine M, Fayol L. et al. Neighborhood disadvantage and early respiratory outcomes in very preterm infants with bronchopulmonary dysplasia. J Pediatr 2021; 237: 177-182.e1
    CrossrefPubMedGoogle Scholar
  • 27 Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)–a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 2009; 42 (02) 377-381
    CrossrefPubMedGoogle Scholar
  • 28 Casey JA, Pollak J, Glymour MM, Mayeda ER, Hirsch AG, Schwartz BS. Measures of SES for electronic health record-based research. Am J Prev Med 2018; 54 (03) 430-439
    CrossrefPubMedGoogle Scholar
  • 29 Association of Maternal & Child Health Programs. “Life Course Indicator: Concentrated Disadvantage (LC-06).”. Life Course Metrics Project. Fall 2013 . Accessed May 13, 2024 at: https://amchp.org/wp-content/uploads/2022/02/LC-06_ConcentratedDisad_Final-4-24-2014.pdf
    PubMedGoogle Scholar
  • 30 Lessen R, Crivelli-Kovach A. Prediction of initiation and duration of breast-feeding for neonates admitted to the neonatal intensive care unit. J Perinat Neonatal Nurs 2007; 21 (03) 256-266
    CrossrefPubMedGoogle Scholar
  • 31 Gonya J, Nelin LD. Factors associated with maternal visitation and participation in skin-to-skin care in an all referral level IIIc NICU. Acta Paediatr 2013; 102 (02) e53-e56
    CrossrefPubMedGoogle Scholar
  • 32 Okito O, Yui Y, Wallace L. et al. Parental resilience and psychological distress in the neonatal intensive care unit. J Perinatol 2022; 42 (11) 1504-1511
    CrossrefPubMedGoogle Scholar
  • 33 Rauh VA, Andrews HF, Garfinkel RS. The contribution of maternal age to racial disparities in birthweight: a multilevel perspective. Am J Public Health 2001; 91 (11) 1815-1824
    CrossrefPubMedGoogle Scholar
  • 34 Culhane JF, Elo IT. Neighborhood context and reproductive health. Am J Obstet Gynecol 2005; 192 (05) S22-S29
    CrossrefPubMedGoogle Scholar
  • 35 Kane JB, Miles G, Yourkavitch J, King K. Neighborhood context and birth outcomes: going beyond neighborhood disadvantage, incorporating affluence. SSM Popul Health 2017; 3: 699-712
    CrossrefPubMedGoogle Scholar
  • 36 Williams DR, Collins C. Racial residential segregation: a fundamental cause of racial disparities in health. Public Health Rep 2001; 116 (05) 404-416
    CrossrefPubMedGoogle Scholar
  • 37 Raiskila S, Axelin A, Toome L. et al. Parents' presence and parent-infant closeness in 11 neonatal intensive care units in six European countries vary between and within the countries. Acta Paediatr 2017; 106 (06) 878-888
    CrossrefPubMedGoogle Scholar
  • 38 Shim JK. Cultural health capital: a theoretical approach to understanding health care interactions and the dynamics of unequal treatment. J Health Soc Behav 2010; 51 (01) 1-15
    CrossrefPubMedGoogle Scholar
  • 39 Vittner D, Butler S, Smith K. et al. Parent engagement correlates with parent and preterm infant oxytocin release during skin-to-skin contact. Adv Neonatal Care 2019; 19 (01) 73-79
    CrossrefPubMedGoogle Scholar
  • 40 Conde-Agudelo A, Díaz-Rossello JL. Kangaroo mother care to reduce morbidity and mortality in low birthweight infants. Cochrane Database Syst Rev 2016; 2016 (08) CD002771
    PubMedGoogle Scholar
  • 41 Patel AL, Schoeny ME, Hoban R. et al. Mediators of racial and ethnic disparity in mother's own milk feeding in very low birth weight infants. Pediatr Res 2019; 85 (05) 662-670
    CrossrefPubMedGoogle Scholar
  • 42 Bourque SL, Weikel BW, Palau MA. et al. The association of social factors and time spent in the NICU for mothers of very preterm infants. Hosp Pediatr 2021; 11 (09) 988-996
    CrossrefPubMedGoogle Scholar
  • 43 United States Census Bureau. Glossary. Last revised April 11, 2022 . Accessed June 3, 2023 at: https://www.census.gov/programs-surveys/geography/about/glossary.html#par_textimage_13
    PubMedGoogle Scholar
  • 44 Cheng TL, Goodman E. Committee on Pediatric Research. Race, ethnicity, and socioeconomic status in research on child health. Pediatrics 2015; 135 (01) e225-e237
    CrossrefPubMedGoogle Scholar