Effect of Health Insurance Status and Visitation Restrictions on Virtual Visitation Technology in the Neonatal Intensive Care Unit

Abstract

Objective This study aimed to examine the relationship between virtual technology system utilization and insurance status or type of visitation restrictions in a single-center neonatal intensive care unit.

Study Design Prospective cohort study with separate analyses performed based on insurance status (public vs. nonpublic) and “in effect” unit visitation restrictions. The three study epochs based on patient visitation restrictions were Epoch 1 (July to October 2019) with standard visitation restrictions, Epoch 2 (November 2019 to February 2020) with respiratory syncytial virus/influenza visitation restrictions, and Epoch 3 (March to June 2020) with coronavirus disease 2019 (COVID-19) visitation restrictions, respectively.

Results Families of 357 infants used web-based cameras through most of the infant's hospitalization (median: 86.05%, Q3: 97.9%) with 165,795 total camera logins, indicating consistent utilization. There was a trend for fewer logins per infant and significantly longer time to consent (p = 0.03) in the Public Insurance group. Unit visitation restrictions impacted the time to consent, the shortest being in Epoch 3 during the COVID-19 pandemic (p = 0.03).

Conclusion Virtual visitation technology is well embraced by neonatal instensive care unit families; however, gaps in access and use among subgroups signals a form of social inequality that needs to be explored further.

Key Points

• Virtual visitation technology can bridge the distance gap for families of hospitalized infants.

• Utilization of virtual technology is affected by socioeconomic factors and seasonal unit visitation restrictions.

• Factors influencing disparities in access and utilization of virtual technology need to be investigated further.

Keywords

family-centered care - neonates and infants - health care insurance - visitation restrictions - inpatient virtual technology - social disparity

Data Availability

The data generated and analyzed during the current study are not publicly available through a repository but are available from the corresponding author on reasonable request and may require institutional data agreements.

Authors' Contributions

B.M.S. was responsible for the study concept. All authors took part in the design of the study. All authors wrote part of the manuscript, gave feedback, and made modifications to the manuscript. Statistical analysis was performed by A.R.S. All authors had access to the study data, reviewed the results, approved the final version of the manuscript, and agreed to be accountable for all aspects of the work.

^* These authors contributed equally to this work.

Publication History

Received: 14 November 2023

Accepted: 11 October 2023

Accepted Manuscript online:
12 October 2023

Article published online:
08 November 2023

• References

• 1 Winston R, Chicot R. The importance of early bonding on the long-term mental health and resilience of children. London J Prim Care (Abingdon) 2016; 8 (01) 12-14
• 2 Craig JW, Glick C, Phillips R, Hall SL, Smith J, Browne J. Recommendations for involving the family in developmental care of the NICU baby. J Perinatol 2015; 35 (Suppl. 01) S5-S8
• 3 Swain JE, Lorberbaum JP, Kose S, Strathearn L. Brain basis of early parent-infant interactions: psychology, physiology, and in vivo functional neuroimaging studies. J Child Psychol Psychiatry 2007; 48 (3-4): 262-287
• 4 Sullivan R, Perry R, Sloan A, Kleinhaus K, Burtchen N. Infant bonding and attachment to the caregiver: insights from basic and clinical science. Clin Perinatol 2011; 38 (04) 643-655
• 5 Nakano M, Upadhyaya S, Chudal R. et al. Risk factors for impaired maternal bonding when infants are 3 months old: a longitudinal population based study from Japan. BMC Psychiatry 2019; 19 (01) 87
• 6 Gibson R, Kilcullen M. The impact of web-cameras on parent-infant attachment in the neonatal intensive care unit. J Pediatr Nurs 2020; 52: e77-e83
• 7 Epstein EG, Arechiga J, Dancy M, Simon J, Wilson D, Alhusen JL. Integrative review of technology to support communication with parents of infants in the NICU. J Obstet Gynecol Neonatal Nurs 2017; 46 (03) 357-366
• 8 Pipp-Siegel S, Easterbrooks MA, Brown SR, Harmon RJ. The relationship between infants' self/mother knowledge and three attachment categories. Infant Ment Health J 1995; 16 (03) 221-232
• 9 Schaber R, Kopp M, Zähringer A, Mack JT, Kress V, Garthus-Niegel S. Paternal leave and father-infant bonding: findings from the population-based cohort study DREAM. Front Psychol 2021; 12: 668028
• 10 Lean RE, Rogers CE, Paul RA, Gerstein ED. NICU hospitalization: long-term implications on parenting and child behaviors. Curr Treat Options Pediatr 2018; 4 (01) 49-69
• 11 Lee HC, Bennett MV, Schulman J, Gould JB. Accounting for variation in length of NICU stay for extremely low birth weight infants. J Perinatol 2013; 33 (11) 872-876
• 12 Flacking R, Lehtonen L, Thomson G. et al; Separation and Closeness Experiences in the Neonatal Environment (SCENE) group. Closeness and separation in neonatal intensive care. Acta Paediatr 2012; 101 (10) 1032-1037
• 13 Rhoads SJ, Green AL, Lewis SD, Rakes L. Challenges of implementation of a web-camera system in the neonatal intensive care unit. Neonatal Netw 2012; 31 (04) 223-228
• 14 Rhoads SJ, Green A, Mitchell A, Lynch CE. Neuro-protective core measure 2: partnering with families—exploratory study on web-camera viewing of hospitalized infants and the effect on parental stress, anxiety, and bonding. Newborn Infant Nurs Rev 2015; 15 (03) 104-110
• 15 Rhoads SJ, Green A, Gauss CH, Mitchell A, Pate B. Web camera use of mothers and fathers when viewing their hospitalized neonate. Adv Neonatal Care 2015; 15 (06) 440-446
• 16 Kerr S, King C, Hogg R. et al. Transition to parenthood in the neonatal care unit: a qualitative study and conceptual model designed to illuminate parent and professional views of the impact of webcam technology. BMC Pediatr 2017; 17 (01) 158
• 17 Shui JE, Messina M, Hill-Ricciuti AC. et al. Impact of respiratory viruses in the neonatal intensive care unit. J Perinatol 2018; 38 (11) 1556-1565
• 18 Le Bris A, Mazille-Orfanos N, Simonot P. et al. Parents' and healthcare professionals' perceptions of the use of live video recording in neonatal units: a focus group study. BMC Pediatr 2020; 20 (01) 143
• 19 Pang EM, Sey R, De Beritto T, Lee HC, Powell CM. Advancing health equity by translating lessons learned from NICU family visitations during the COVID-19 pandemic. Neoreviews 2021; 22 (01) e1-e6
• 20 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
• 21 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
• 22 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
• 23 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
• 24 Beck AF, Edwards EM, Horbar JD, Howell EA, MccCormick MC, Pursley DM. The color of health: how racism, segregation, and inequality affect the health and well-being of preterm infants and their families. Pediatr Res 2020; 87: 227-234
• 25 Klawetter S, Neu M, Roybal KL, Greenfield JC, Scott J, Hwang S. Mothering in the NICU: a qualitative exploration of maternal engagement. Soc Work Health Care 2019; 58 (08) 746-763
• 26 Benjamin GC. Ensuring health equity during the COVID-19 pandemic: the role of public health infrastructure. Rev Panam Salud Publica 2020; 44: e70
• 27 Virani AK, Puls HT, Mitsos R, Longstaff H, Goldman RD, Lantos JD. Benefits and risks of visitor restrictions for hospitalized children during the COVID pandemic. Pediatrics 2020; 146 (02) 1-6
• 28 Huckabay LM. Impact of a research study a decade later: the use of pictures in a neonatal intensive care unit as a mode of nursing intervention to enhance maternal-infant bonding. Sch Inq Nurs Pract 1999; 13 (04) 367-373
• 29 Gray JE, Safran C, Davis RB. et al. Baby CareLink: using the internet and telemedicine to improve care for high-risk infants. Pediatrics 2000; 106 (06) 1318-1324
• 30 Dunham MM, Marin T. Virtual visitation in the NICU: a scoping literature review. J Neonatal Nurs 2022; 29 (01) 2-9
• 31 Yeo CL, Ho SKY, Khong KC, Lau YY. Virtual visitation in the neonatal intensive care: experience with the use of internet and telemedicine in a tertiary neonatal unit. Acta Paediatr 2012; 101 (10) 1032-1037
• 32 Joshi A, Chyou PH, Tirmizi Z, Gross J. Web camera use in the neonatal intensive care unit: impact on nursing workflow. Clin Med Res 2016; 14 (01) 1-6
• 33 Hawkes GA, Livingstone V, Ryan CA, Dempsey EM. Perceptions of webcams in the neonatal intensive care unit: here's looking at you kid!. Am J Perinatol 2015; 30 (02) 131-136
• 34 Kubicka Z, Zahr E, Clark P, Williams D, Berbert L, Arzuaga B. Use of an internet camera system in the neonatal intensive care unit: parental and nursing perspectives and its effects on stress. J Perinatol 2021; 41 (08) 2048-2056
• 35 Thibeau S, Ricouard D, Gilcrease C. Innovative technology offers virtual visitation for families. J Contin Educ Nurs 2012; 43 (10) 439-440
• 36 Kalaniti K, Mugarab-Samedi V, Riehl A, Bingham W, Daspal S. Mission possible: keeping families connected during COVID-19 pandemic. Oman Med J 2021; 36 (05) e309
• 37 Murray PD, Swanson JR. Visitation restrictions: is it right and how do we support families in the NICU during COVID-19?. J Perinatol 2020; 40 (10) 1576-1581
• 38 Liberatos P, Link BG, Kelsey JL. The measurement of social class in epidemiology. Epidemiol Rev 1988; 10: 87-121
• 39 Hebert PL, Chassin MR, Howell EA. The contribution of geography to black/white differences in the use of low neonatal mortality hospitals in New York City. Med Care 2011; 49 (02) 200-206
• 40 Lorch SA. Health equity and quality of care assessment: a continuing challenge. Pediatrics 2017; 140 (03) e20172213
• 41 Sigurdson K, Mitchell B, Liu J. et al. Racial/ethnic disparities in neonatal intensive care: a systematic review. Pediatrics 2019; 144 (02) e20183114
• 42 Ranganathan D, Wall S, Khoshnood B, Singh JK, Lee KS. Racial differences in respiratory-related neonatal mortality among very low birth weight infants. J Pediatr 2000; 136 (04) 454-459
• 43 Townsel C, Keller R, Kuo CL, Campbell WA, Hussain N. Racial/ethnic disparities in morbidity and mortality for preterm neonates admitted to a tertiary neonatal intensive care unit. J Racial Ethn Health Disparities 2018; 5 (04) 867-874
• 44 Compaine BM. The Digital Divide: Facing a Crisis or Creating a Myth?. Cambridge: MIT Press; 2001
• 45 Perzynski AT, Roach MJ, Shick S. et al. Patient portals and broadband internet inequality. J Am Med Inform Assoc 2017; 24 (05) 927-932
• 46 Sieck CJ, Sheon S, Ancke JSr, Castek J, Callahan B, Siefer A. Digital inclusion as a social determinant of health. NPJ Digit Med 2021; 52: 1-3
• 47 Muniraman H, Ali M, Cawley P. et al. Parental perceptions of the impact of neonatal unit visitation policies during COVID-19 pandemic. BMJ Paediatr Open 2020; 4 (01) e000899
• 48 Obeidat HM, Bond EA, Callister LC. The parental experience of having an infant in the newborn intensive care unit. J Perinat Educ 2009; 18 (03) 23-29
• 49 Mahoney AD, White RD, Velasquez A, Barrett TS, Clark RH, Ahmad KA. Impact of restrictions on parental presence in neonatal intensive care units related to coronavirus disease 2019. J Perinatol 2020; 40 (Suppl. 01) 36-46