183 - Socioeconomic disparities in NICU visitation and skin-to-skin care in the setting of COVID-19

Poster Number: 183
Publication Number: 183.234

Melanie Kasaris, Ohio University Heritage College of Medicine, Broadview Heights, OH, United States; Barb Gareau, Fairview, cleveland, OH, United States; Samantha Bastian, Cleveland Clinic Children's, Cleveland, OH, United States; Emily Mudd, Cleveland Clinic Children's, Cleveland, OH, United States; Anirudha Das, Cleveland Clinic, Cleveland, OH, United States

Background: Social and medical factors impact parental presence and skin-to-skin care of infants in the NICU. Parents in lower socioeconomic strata have limited access to the NICU and skin-to-skin time with their infants, which are essential determinants of neurodevelopmental outcomes in premature infants. During the pandemic, restrictions by the government agencies, disruption of everyday life, and visitation regulations of the hospitals limited the time spent by the parents at their infant's bedside.

Objective: The study aims to ascertain the effect of socioeconomic status on parents' number of NICU visits, time spent in skin-to-skin care, and the pandemic's impact on those two determinants of neonatal outcome.

Design/Methods: In this retrospective cohort study, infant-parent dyads admitted to the NICU were divided into two groups based on maternal insurance – government (Govt) and private (Pvt). Only infants admitted to the NICU for at least 3 weeks and mothers who completed the Depression Anxiety and Stress Scale -21 (DASS-21) screening were included in the study. The effect of the pandemic on visitation was compared between epoch 1 (January 2019 to December 2019) and epoch 2 (September 2020 to January 2021). Visitation and skin-to-skin care duration for every infant were tallied for 4 weeks – weeks 2 through 5 from the electronic medical record.

Results: A total of 77 infant-parent dyads were included in the study (twins considered single subjects) (Table 1). Fifty parents were in Govt and 27 in the Pvt insurance group. There was no difference in gestation, birth weight, length of stay, distance from home and depression, anxiety and stress scores between the groups. The govt insurance group had more African Americans (p < 0.01), lower maternal age (p=0.04), lower weekly average show-up rate (p < 0.01), and lower total skin-to-skin time (p=0.01) compared to the Pvt insurance group. Compared to the pre-pandemic epoch 1, the gap between the govt and Pvt visitation percentages and the duration of skin-to-skin care narrowed during the pandemic (epoch 2). Differences in average weekly show-up rate (p= 0.01) and skin-to-skin (p=0.03) were significant in epoch 1 between the groups but not in epoch 2 (p=0.53 and p=0.65 respectively) (Table 2).Conclusion(s): Parents in the lower socioeconomic strata had significantly lower visitation and skin-to-skin time with their infants. The gap in visitation and skin-to-skin time between the groups narrowed during the pandemic signifying a decline in disparities. This could result from changes in hospital visitation policies or unknown external factors requiring further research.
Table 1Characteristics of the two study groups. All characteristics show the median and range except distance home to hospital, weekly average show up rate and total skin-to-skin care duration which show the mean and standard deviation. ** P < 0.05.
Table 2Comparison of the differences between average weekly show-up percentages and skin-to-skin time pre-pandemic vs pandemic. **p < 0.05.