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Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
Unmet Health and Childcare Needs after Neonatal Intensive Care Unit Discharge
Tamiko Younge1, Marni Jacobs2, Lamia Soghier3
1Neonatal-Perinatal Medicine Fellow, Division of Neonatology, Children's National Hospital, Washington, District of Columbia.
Insights
Families discharged from the neonatal intensive care unit (NICU) face unmet health and childcare needs, with racial disparities observed. Parental self-efficacy may help reduce these unmet needs.
Area of Science:
- Neonatal care
- Health services research
- Health equity
Background:
- Infants discharged from the neonatal intensive care unit (NICU) require ongoing health and childcare support.
- Unmet needs post-NICU discharge can impact infant outcomes and family well-being.
- Parental self-efficacy plays a role in navigating healthcare systems and accessing resources.
Purpose of the Study:
- To identify unmet health and childcare needs in families 12 months after NICU discharge.
- To examine associations between unmet needs and infant characteristics, parent characteristics, and parent self-efficacy.
- To explore racial disparities in unmet needs and the potential moderating role of self-efficacy.
Main Methods:
- Secondary analysis of a randomized control trial using mixed methods.
- Parents reported on the receipt of seven health and childcare services 12 months post-discharge.
- Logistic regression and thematic analysis of open-ended responses were employed.
Main Results:
- 14% of families reported at least one unmet need.
- Greater infant illness severity and longer NICU stay were associated with increased unmet needs.
- Black parents had significantly higher odds of unmet needs compared to White parents, potentially moderated by self-efficacy.
Conclusions:
- Significant unmet health and childcare needs exist post-NICU discharge, with notable racial disparities.
- Higher parental self-efficacy is linked to fewer unmet needs and may mitigate racial disparities.
- NICU follow-up programs should actively screen for and address unmet needs in high-risk populations.
Abstract:
This study aimed to identify unmet health and childcare needs and associations with infant characteristics, parent characteristics, and parent self-efficacy after neonatal intensive care unit (NICU) discharge.We conducted a secondary mixed-methods analysis of data from a single-center randomized control trial. Twelve months after discharge, parents reported if their child did not need, need and received, or needed but did not receive seven health and childcare services. Associations with infant characteristics, parent characteristics, and parent self-efficacy were assessed using logistic regression. Open-ended responses were analyzed for themes.A total of 241 families completed assessments 12 months after discharge. Thirty-three respondents (14%) reported at least one unmet need. Increasing gestational age decreased the odds of unmet needs (odds ratio [OR]: 0.91; 95% confidence interval [CI]: 0.84-0.97), while longer length of stay and moderate or severe infant functional status increased odds (OR: 1.01; 95% CI: 1.01-1.02; OR: 2.93; 95% CI: 1.14-8.17). Greater self-efficacy was associated with lower odds of unmet needs (OR: 0.91; 95% CI: 0.85-0.97). Black parents had 2.8 times the odds of unmet needs compared to White parents after adjusting for length of stay (95% CI: 1.15-7.54). Self-efficacy may have a moderating effect on this racial disparity. Parents reported needing childcare, psychosocial support, and financial assistance in open-ended responses.We found families experienced unmet health and childcare needs with evident racial disparities in the year after NICU discharge. Greater parental self-efficacy may reduce this racial gap. Pediatric practices and health care systems, especially NICU follow-up programs, should continue to screen and connect this high-risk population to support and resources. · Greater unmet needs after NICU discharge were associated with greater infant illness severity.. · Black parents had greater odds of reporting unmet needs compared to White parents.. · Greater parent self-efficacy was associated with lower odds of unmet needs..
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