Promoting Equity in Parent Presence and Participation in Neonatal Intensive Care: Protocol for a Prospective Cohort Study
Bibliographic record
Abstract
BACKGROUND: Parents of infants born preterm experience many barriers to their presence in the neonatal intensive care unit (NICU) and participation in infant caregiving. Parents from historically marginalized backgrounds or with limited social or economic resources may experience even more profound barriers, creating a significant source of health inequity for these parents and their infants. While the specific barriers and facilitators of parent presence and participation (PPP) in caregiving are unknown, PPP may be critical for improving clinical outcomes and neurodevelopment for infants born preterm. OBJECTIVE: This study aims to (1) longitudinally determine the barriers and facilitators affecting PPP specific to parents with diverse sociodemographic characteristics, (2) determine the effect of PPP on infant clinical outcomes and neurodevelopment and the potential mediating effect of parent-infant responsiveness, and (3) determine the moderation effect of PPP on the relationship between infant stress exposure and infant clinical outcomes and neurodevelopment. We hypothesize that barriers and facilitators of PPP will vary based on sociodemographic characteristics and will change over the duration of a NICU hospitalization. We expect that higher levels of PPP will be associated with better infant outcomes. METHODS: Parents (N=375) of infants born preterm, at <32 weeks' gestational age, will be enrolled in a prospective cohort study. The parents will complete a daily survey documenting the amount of time spent in the NICU and the caregiving activities performed. The parents will also complete surveys at regular intervals during their infant's admission to report barriers and facilitators of PPP, NICU-related stress, depressive symptoms, experiences of discrimination, and engagement with NICU staff. Additional data will be collected throughout each infant's hospitalization, including invasive procedures, infant clinical data, and nursing documentation of PPP. The parents will complete the maternal-infant responsiveness instrument at the time of NICU discharge and at 3 months' corrected age (CA). Infant clinical outcomes include the achievement of feeding milestones and the length of NICU stay. The infants will be assessed at 3 months' CA using the test of infant motor performance and at 12 months' CA using the Bayley scales of infant and toddler development, fourth edition. RESULTS: Funding was awarded in August 2024. Data collection and analysis are expected to be completed by July 2029. CONCLUSIONS: By identifying the important barriers and facilitators of PPP over the duration of hospitalizations of infants born preterm and differences in these factors based on sociodemographic characteristics, time- and population-targeted interventions can be developed to remove system-level barriers and enhance facilitators. These efforts may increase PPP and promote health equity for diverse families. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/71930.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.036 | 0.022 |
| Meta-epidemiology (narrow) | 0.003 | 0.003 |
| Meta-epidemiology (broad) | 0.004 | 0.003 |
| Bibliometrics | 0.003 | 0.004 |
| Science and technology studies | 0.005 | 0.002 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.003 | 0.002 |
| Research integrity | 0.003 | 0.004 |
| Insufficient payload (model declined to judge) | 0.030 | 0.006 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".