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Published on: January 12, 2018
Assessing Neonatal Transport, Health Outcomes, and Psychosocial Inequities Among Black, Very Preterm Infants and
Karen F Warren1, Tisha Felder1, Nansi Boghossian2
1Department of Biobehavioral Health and Nursing Science, College of Nursing, University of South Carolina, 1601 Greene Street, Columbia, SC, 29208, United States, 1 5402572007.
Insights
This study explores neonatal transport
Area of Science:
- Perinatal health research
- Neonatal care and transport
- Health disparities in Black families
Background:
- High preterm birth rates persist in the US, disproportionately impacting Black families.
- Very preterm infants often require transport to specialized NICUs, posing challenges for families.
- Social vulnerability and discrimination can exacerbate stress during neonatal care.
Purpose of the Study:
- Examine associations between neonatal transport and infant/parent outcomes in Black families.
- Investigate how structural inequities influence experiences from birth through NICU hospitalization.
- Inform future research and interventions to support parental mental health and reduce disparities.
Main Methods:
- Longitudinal mixed-methods multiple case study at a South Carolina perinatal center.
- Inclusion of up to 10 cases of very preterm Black infants requiring transport.
- Data collection includes infant outcomes, neighborhood disadvantage (Area Deprivation Index), parent surveys, and semistructured interviews.
Main Results:
- Study protocol and analytic plan are reported; detailed results are forthcoming.
- Participant enrollment and data collection phases are complete.
- Companion manuscripts with detailed findings are under review, with anticipated publication in fall 2026.
Conclusions:
- Novel mixed-methods case study protocol on neonatal transport and outcomes for Black families.
- Exploratory study aims to generate hypotheses for future research and intervention development.
- Focus on improving parental mental health, reducing disparities, and enhancing care experiences.
Background:
Despite medical advancements, preterm birth rates in the United States remain high and contribute substantially to infant mortality and long-term morbidity, with Black families disproportionately affected. Very preterm (VPT) infants-born between 24 and 30 weeks' gestation-are frequently delivered at community hospitals that lack advanced neonatal care and therefore require postnatal transport to tertiary neonatal intensive care units (NICUs). While neonatal transport is essential for optimizing infant outcomes, it can create additional challenges for families, including geographic separation from the NICU, disruptions to early parent-infant bonding, and increased parental psychosocial stress. These challenges may be further intensified by social vulnerability and experiences of perceived discrimination in health care settings.
Objective:
This study examines associations between neonatal transport, infant health outcomes, and the psychosocial well-being of Black parents with VPT infants. It also examines how structural inequities and social vulnerability shape experiences from delivery through NICU hospitalization.
Methods:
This protocol describes a longitudinal mixed methods multiple case study at a single perinatal center in South Carolina. Up to 10 cases of VPT Black infants transported from community hospitals between May 2023 and January 2024 are included. Each case includes the infant and mother, with partners invited. Quantitative data include infant outcomes from electronic medical records, neighborhood disadvantage using the Area Deprivation Index, and parent surveys of stress, anxiety, depression, bonding, perceived discrimination, and access to care. Qualitative data come from semistructured interviews guided by an adaptation of the National Institute on Minority Health and Health Disparities Research Framework and analyzed using reflexive thematic analysis. Data are integrated within each case to create structured summaries, followed by cross-case comparisons to identify patterns and variation.
Results:
The study was funded by the National Institute of Nursing Research in July 2023. Participant enrollment occurred between May 2023 and January 2024, with 6 cases enrolled. Data collection and electronic medical record abstraction were completed in May 2024, with analysis completed by July 2024. This manuscript reports the protocol and analytic plan. Detailed results will be reported in 2 companion manuscripts currently under review; publication of one is anticipated in fall 2026.
Conclusions:
This protocol outlines a novel mixed methods case study of neonatal transport and infant and parent outcomes among Black families. The study is exploratory and intended to generate hypotheses and inform future larger scale research and intervention development to support parental mental health, reduce disparities, and improve care experiences following preterm birth and neonatal transport.
