469 - Associations of Maternal Social Factors and Presence & Participation in NICU Bedside Cares

Poster Number: 469
Publication Number: 469.129

Nikita S. Kalluri, Boston Children's Hospital, Boston, MA, United States; Erin Wade, Boston University, Boston, MA, United States; Erika G. Cordova Ramos, Boston Medical Center (BMC) - - Boston, MA, Jamacia Plain, MA, United States; Margaret Parker, Boston Medical Center, Boston, MA, United States

Background: Maternal participation in NICU infant care is strongly encouraged because of its associated benefits, including breastfeeding, skin-to-skin and growth. However, recent evidence suggests that participation in care can be more challenging for socially disadvantaged mothers. The impact of social factors on maternal participation in infant care is poorly understood.

Objective: Among infants born < 35 weeks’ gestation, we examined the association of maternal social factors (primary language, race/ethnicity, and insurance status) and (1) NICU presence and (2) documented participation in infant care times when mothers were present.

Design/Methods: We abstracted medical record data at a single-center inner-city level 3 NICU, including mother-infant dyads with infants < 35 weeks’ gestation admitted from 5/2014-5/2020. Maternal presence (yes/no) and participation in care times ("active in cares"; "holding"; and/or "skin to skin" [yes/no for each]) were abstracted from nursing notes. NICU presence was defined as average days per week. Social factors of interest were primary language, race/ethnicity, and insurance status. We examined bivariate associations of average days/week of presence and social factors and examined multivariate associations of social factors with participation in cares when mothers were present, adjusting for birth weight, gestational age, and maternal age.

Results: Among 378 mothers, 30% were Hispanic and 46% were non-Hispanic black (NHB). 63% spoke English, 18% spoke Spanish, and 9% spoke Haitian Creole. 74% had public insurance. The median days/week mothers were present was 6.5 (IQR 1.3); this was lower for Haitian Creole speaking mothers, compared to English-speaking mothers (5.8 vs. 6.6 days), and NHB mothers, compared to non-Hispanic White (NHW) mothers (6.4 vs. 6.8 days) (Figure).  Compared to NHW mothers, NHB mothers were less likely to be active in cares (adjusted risk difference [RD] -15.3%, 95%CI -20.5, -10.2), holding (RD -11.8%, 95%CI -18.4, -5.1) or performing skin to skin (RD -9.0%, 95%CI -16.6, -1.5) and Hispanic mothers were less likely to be active in cares (RD -7.8%, 95%CI -13.3, -2.2). Compared to English-speaking mothers, Haitian Creole speaking-mothers were less likely to be active in cares (RD -8.6%, 95%CI -15.7, -1.4) (Table).Conclusion(s): Maternal bedside presence and participation in infant cares was less frequent for racial/ethnic minority and Haitian Creole-speaking mothers in an urban, inner-city NICU. Possible etiologies may include barriers to transportation and childcare, implicit bias of staff, and quality/quantity of interpreter services.
Bivariate comparison of average number of days per week throughout the hospitalization with maternal presence at bedside by social factors*p < 0.05. Box-and-whisker plots displaying median values and the interquartile range for ‘average number of days per week’ that mothers were present at the bedside, by i) primary language, ii) race/ethnicity, and iii) insurance type.
Association of maternal social factors and documented participation in infant cares during care times throughout the hospitalization when mothers were present*Models were adjusted for gestational age, birth weight, and maternal age, with clustering used for plurality. Bolded values are significant.
**Participation in cares defined by percentage of care times when mothers were present that they were documented as i) active in cares, ii) holding, and/or iii) skin to skin