Effect of Support for Low-Income Mothers of Preterm Infants
Effect of Support for Low-Income Mothers of Preterm Infants on Parental Caregiving in the Neonatal Intensive Care Unit (NICU)
Study Overview
Status
Status
Conditions
Conditions
Intervention / Treatment
Intervention / Treatment
Study Type
Study Type
Enrollment (Estimated)
Enrollment
Phase
Phase
- Not Applicable
Contacts and Locations
Study Contact
Study Contact
- Name: Margaret McConnell, PhD
- Phone Number: 203-745-8321
- Email: mmcconne@hsph.harvard.edu
Study Locations
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Georgia
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Atlanta, Georgia, United States, 30322
- Recruiting
- Children's Healthcare of Atlanta and Emory University
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Contact:
- Michelle-Marie Peña, MD
- Email: michelle.marie.pena@emory.edu
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Massachusetts
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Boston, Massachusetts, United States, 02118
- Recruiting
- Boston Medical Center
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Contact:
- Gabriela Cordova Ramos, MD
- Email: gabriela.CordovaRamos@bmc.org
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Springfield, Massachusetts, United States, 01199
- Recruiting
- Baystate Medical Center
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Contact:
- Laura Madore, MD
- Email: laura.Madore@baystatehealth.org
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Worcester, Massachusetts, United States, 01605
- Recruiting
- UMass Memorial Medical Center
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Contact:
- Margaret Parker, MD
- Email: margaret.Parker@umassmemorial.org
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Participation Criteria
Eligibility Criteria
Eligibility Criteria
Ages Eligible for Study
- Adult
- Older Adult
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- Mother is eligible for Medicaid insurance.
- Has an infant or infants born 24 0/7-34 1/7 weeks gestation.
- Mother's baby is cared for at one of the four enrolling study sites located in Massachusetts or Georgia.
- Mother is eligible to breastfeed (per hospital criteria).
Exclusion Criteria:
- Mother is not English- or Spanish-speaking.
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Health Services Research
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Double
Number of Arms
Arms and Interventions
Participant Group / ArmParticipant Group / Arm |
Intervention / TreatmentIntervention / Treatment |
|---|---|
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No Intervention: Usual Care
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Experimental: Financial Transfers
Mothers assigned to the intervention group will be informed that they are eligible to receive financial transfers $160/week on a "CuddleCard" debit-card with a one- time "label" or scripted message that states: "This money is intended to help you to spend more time visiting and caring for your infant(s) in the NICU."
Financial transfers will begin 1 week after birth or when the mother is discharged (whichever comes later) until the infant is discharged, except in cases where the hospitalization lasts beyond 42 weeks corrected age.
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Mothers assigned to the intervention group will be informed that they are eligible to receive financial transfers $160/week on a debit-card with a one-time "label" or scripted message that states: "This money is intended to help you to spend more time visiting and caring for your infant(s) in the NICU."
Financial transfers will begin 1 week after birth or when the mother is discharged (whichever comes later) until the infant is discharged, except in cases where the hospitalization lasts beyond 42 weeks corrected age.
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What is the study measuring?
Primary Outcome Measures
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
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Provision of breast milk (proportion)
Time Frame: From NICU admission to discharge or 42 weeks corrected gestational age, whichever comes earlier (maximum of 18 weeks)
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Proportion of nursing shift-total enteral intake that is maternal breast milk fed via gavage tube or bottle.
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From NICU admission to discharge or 42 weeks corrected gestational age, whichever comes earlier (maximum of 18 weeks)
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Provision of skin-to-skin care
Time Frame: From NICU admission to discharge or 42 weeks corrected gestational age, whichever comes earlier (maximum of 18 weeks)
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Proportion of nursing shifts where mother performs skin-to-skin care for at least one hour.
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From NICU admission to discharge or 42 weeks corrected gestational age, whichever comes earlier (maximum of 18 weeks)
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Secondary Outcome Measures
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
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Gestational weight-for-age
Time Frame: Extracted from medical records 1-2 weeks after discharge from the NICU
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Change in sex-specific gestational weight-for-age z-score while admitted to the NICU.
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Extracted from medical records 1-2 weeks after discharge from the NICU
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Gestational length-for-age z-score
Time Frame: Extracted from medical records 1-2 weeks after discharge from the NICU
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Change in sex-specific gestational length-for-age z-score while admitted to the NICU.
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Extracted from medical records 1-2 weeks after discharge from the NICU
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Gestational head circumference
Time Frame: Extracted from medical records 1-2 weeks after discharge from the NICU
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Change in sex-specific gestational head circumference z-score while admitted to the NICU.
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Extracted from medical records 1-2 weeks after discharge from the NICU
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Necrotizing enterocolitis (NEC)
Time Frame: Extracted from medical records 1-2 weeks after discharge from the NICU
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Experienced NEC during NICU stay according to Vermont Oxford Network (VON) definition; criteria: yes/no.
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Extracted from medical records 1-2 weeks after discharge from the NICU
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Late-onset bacterial or fungal sepsis (LOS)
Time Frame: Extracted from medical records 1-2 weeks after discharge from the NICU
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Experienced with LOS during NICU stay according to Vermont Oxford Network (VON) definition; criteria: yes/no.
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Extracted from medical records 1-2 weeks after discharge from the NICU
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NICU Visitation
Time Frame: From NICU admission to discharge or 42 weeks corrected gestational age, whichever comes earlier (maximum of 18 weeks)
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Proportion of nursing shifts where mother is present in the NICU.
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From NICU admission to discharge or 42 weeks corrected gestational age, whichever comes earlier (maximum of 18 weeks)
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Postpartum Bonding
Time Frame: Measured in the post-discharge survey within 4-8 week of infant discharge
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Score of mother-infant bonding assessed inspired by the Postpartum Bonding Questionnaire, where participants rate their agreement of statements on Likert scales ranging from 0 (always) to 5 (never); scores range from 0 to 50, with higher scores indicating more bonding challenges.
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Measured in the post-discharge survey within 4-8 week of infant discharge
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Provision of breast milk (volume)
Time Frame: From NICU admission to discharge or 42 weeks corrected gestational age, whichever comes earlier (maximum of 18 weeks)
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Milliliters of nursing shift-total enteral intake that is maternal breast milk fed via gavage tube or bottle.
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From NICU admission to discharge or 42 weeks corrected gestational age, whichever comes earlier (maximum of 18 weeks)
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Breastfeeding episode
Time Frame: From NICU admission to discharge or 42 weeks corrected gestational age, whichever comes earlier (maximum of 18 weeks)
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Occurrence of direct breastfeeding episode during each nursing shift.
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From NICU admission to discharge or 42 weeks corrected gestational age, whichever comes earlier (maximum of 18 weeks)
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Length of stay
Time Frame: Measured within one week of discharge form the NICU
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The total number of days from infant admission to discharge from the hospital.
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Measured within one week of discharge form the NICU
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Mother readmission between 4-8 weeks post-discharge
Time Frame: Measured between 4-8 weeks after discharge of infant from NICU
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Any mother readmission to the hospital after her initial discharge.
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Measured between 4-8 weeks after discharge of infant from NICU
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Baby readmission between 4-8 weeks post-discharge
Time Frame: Measured between 4-8 weeks after discharge of infant from NICU
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Any infant readmission to the hospital after initial discharge.
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Measured between 4-8 weeks after discharge of infant from NICU
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Sleep position
Time Frame: Measured between 4-8 weeks after discharge of infant from NICU
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Mothers report of exclusive infant supine position to sleep in the last two weeks.
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Measured between 4-8 weeks after discharge of infant from NICU
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Sleep location
Time Frame: Measured between 4-8 weeks after discharge of infant from NICU
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Mothers report exclusively using the room-sharing sleep method, where the infant sleeps in the same room as an adult but on a separate crib or sleep surface, without bed-sharing, in the last two weeks.
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Measured between 4-8 weeks after discharge of infant from NICU
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Breastfeeding expression continuation
Time Frame: Measured between 4-8 weeks after discharge of infant from NICU
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Mothers report of breastfeeding continuation.
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Measured between 4-8 weeks after discharge of infant from NICU
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Skin-to-skin care knowledge
Time Frame: Measured within one week of discharge form the NICU
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Mothers report of knowledge about Skin-to-skin (STS) care based on 4 questions.
Scored as a count variable that ranges between 0 and 4.
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Measured within one week of discharge form the NICU
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Breastfeeding knowledge
Time Frame: Measured within one week of discharge form the NICU
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Mothers report of knowledge about breastfeeding based on 7 questions.
Scored as a count variable that ranges between 0 and 7.
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Measured within one week of discharge form the NICU
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Perception of hospital experience
Time Frame: Measured between 4-8 weeks after discharge of infant from NICU
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Assesses mothers' overall perception of hospital experience and hospital services during their stay, using a scale from 0 (worst hospital possible) to 10 (best hospital possible).
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Measured between 4-8 weeks after discharge of infant from NICU
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Reaction Time Attention Network Test-Revised (ANT-R).
Time Frame: Measured biweekly from NICU admission to discharge or 42 weeks corrected gestational age, whichever comes earlier (maximum of 18 weeks)
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Average response time across all trials to assess overall speed of responses.
Lower scores indicate faster reaction times and better attentional performance.
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Measured biweekly from NICU admission to discharge or 42 weeks corrected gestational age, whichever comes earlier (maximum of 18 weeks)
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Accuracy Performance Attention Network Test-Revised (ANT-R).
Time Frame: Measured biweekly from NICU admission to discharge or 42 weeks corrected gestational age, whichever comes earlier (maximum of 18 weeks)
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Proportion of accurate responses on the ANT-R.
Higher scores indicate higher accurate responses.
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Measured biweekly from NICU admission to discharge or 42 weeks corrected gestational age, whichever comes earlier (maximum of 18 weeks)
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Reaction Time Psychomotor Vigilance Task
Time Frame: Measured biweekly from NICU admission to discharge or 42 weeks corrected gestational age, whichever comes earlier (maximum of 18 weeks)
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Average reaction time across trials, assessing overall speed and vigilance.
Lower scores indicate quicker reaction times and heightened vigilance.
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Measured biweekly from NICU admission to discharge or 42 weeks corrected gestational age, whichever comes earlier (maximum of 18 weeks)
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Accuracy Psychomotor Vigilance Task
Time Frame: Measured biweekly from NICU admission to discharge or 42 weeks corrected gestational age, whichever comes earlier (maximum of 18 weeks)
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Percentage of correct responses out of the total number of trials on the Psychomotor Vigilance Task (PVT).
Higher scores indicate higher accurate responses.
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Measured biweekly from NICU admission to discharge or 42 weeks corrected gestational age, whichever comes earlier (maximum of 18 weeks)
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Duration of mother's milk expression
Time Frame: From NICU admission through to 12 months postpartum
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Months of milk expression via direct breastfeeding or pumping.
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From NICU admission through to 12 months postpartum
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Maternal physical health
Time Frame: Measured biweekly from NICU admission to discharge or 42 weeks corrected gestational age, whichever comes earlier (maximum of 18 weeks); post-discharge (4-8 weeks); 6 months postpartum; 12 months postpartum
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Score of self-reported Short Form Health Survey -1 Physical Health Item; assesses participants' perception of their current physical health.
Lower score indicates worse perceived physical health.
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Measured biweekly from NICU admission to discharge or 42 weeks corrected gestational age, whichever comes earlier (maximum of 18 weeks); post-discharge (4-8 weeks); 6 months postpartum; 12 months postpartum
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Maternal mental health (anxiety)
Time Frame: Measured biweekly from NICU admission to discharge or 42 weeks corrected gestational age, whichever comes earlier (maximum of 18 weeks); post-discharge (4-8 weeks); 6 months postpartum; 12 months postpartum
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Score of self-reported 10-item Perceived Stress Scale (PSS-10); assesses the perceived stress levels experienced in terms of overstrain, unmanageability, and unpredictability in the past month.
Higher score indicates worse outcome.
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Measured biweekly from NICU admission to discharge or 42 weeks corrected gestational age, whichever comes earlier (maximum of 18 weeks); post-discharge (4-8 weeks); 6 months postpartum; 12 months postpartum
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Maternal mental health (depression)
Time Frame: Measured biweekly from NICU admission to discharge or 42 weeks corrected gestational age, whichever comes earlier (maximum of 18 weeks); post-discharge (4-8 weeks); 6 months postpartum; 12 months postpartum
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Score of the Edinburgh Postnatal Depression Scale (EPDS), a 10-item self-report measure of postpartum depression (ranges from 0-30) with a higher score indicating worse depressive symptoms.
The EPDS was developed to assist health professionals in detecting mothers suffering from postpartum depression (PPD).
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Measured biweekly from NICU admission to discharge or 42 weeks corrected gestational age, whichever comes earlier (maximum of 18 weeks); post-discharge (4-8 weeks); 6 months postpartum; 12 months postpartum
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Happiness
Time Frame: Measured biweekly from NICU admission to discharge or 42 weeks corrected gestational age, whichever comes earlier (maximum of 18 weeks); post-discharge (4-8 weeks); 6 months postpartum; 12 months postpartum
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Score on Happiness Indicator from Integrated Values Surveys; assesses the overall and current perceived level of happiness experienced; with a 4-point scale from 0 (Not at all happy) to 3 (Very Happy).
Higher score indicates better perceived level of happiness.
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Measured biweekly from NICU admission to discharge or 42 weeks corrected gestational age, whichever comes earlier (maximum of 18 weeks); post-discharge (4-8 weeks); 6 months postpartum; 12 months postpartum
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Life satisfaction
Time Frame: Measured biweekly from NICU admission to discharge or 42 weeks corrected gestational age, whichever comes earlier (maximum of 18 weeks); post-discharge (4-8 weeks); 6 months postpartum; 12 months postpartum
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Score of the Life Satisfaction Scale Item; assesses participants' perception of their current overall life satisfaction; with a 4-point scale from 0 (Very Satisfied) to 3 (Not At All Satisfied), and was reverse-coded such that higher scores indicate better perceived life satisfaction.
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Measured biweekly from NICU admission to discharge or 42 weeks corrected gestational age, whichever comes earlier (maximum of 18 weeks); post-discharge (4-8 weeks); 6 months postpartum; 12 months postpartum
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Sleep
Time Frame: Measured biweekly from NICU admission to discharge or 42 weeks corrected gestational age, whichever comes earlier (maximum of 18 weeks); post-discharge (4-8 weeks); 6 months postpartum; 12 months postpartum
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Score of Sleep Quality Score (SQS) with 7-Day Recall; evaluates the overall quality of sleep.
Core components include sleep duration, ease of falling asleep, frequency of waking during the night (excluding bathroom visits), early waking, and sleep refreshment.
The respondent marks an integer score from 0 to 10, according to the following five categories: 0 = terrible, 1-3 = poor, 4-6 = fair, 7-9 = good, and 10 = excellent.
Higher score indicates better perceived sleep quality.
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Measured biweekly from NICU admission to discharge or 42 weeks corrected gestational age, whichever comes earlier (maximum of 18 weeks); post-discharge (4-8 weeks); 6 months postpartum; 12 months postpartum
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Routine postpartum care
Time Frame: Measured at post-discharge (4-8 weeks after infant discharge from NICU); 6 months postpartum; 12 months postpartum
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Number of routine postpartum follow-up visits attended by mom.
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Measured at post-discharge (4-8 weeks after infant discharge from NICU); 6 months postpartum; 12 months postpartum
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Financial distress
Time Frame: Measured biweekly from NICU admission to discharge or 42 weeks corrected gestational age, whichever comes earlier (maximum of 18 weeks); post-discharge (4-8 weeks); 6 months postpartum; 12 months postpartum
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Score of financial stress during the NICU stay based on two metrics: difficulty in paying bills and remaining money at the end of the week.
Scoring for each question is summed to create an overall financial distress score, ranging from 0 to 8. Higher score indicates higher financial distress.
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Measured biweekly from NICU admission to discharge or 42 weeks corrected gestational age, whichever comes earlier (maximum of 18 weeks); post-discharge (4-8 weeks); 6 months postpartum; 12 months postpartum
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Financial hardship
Time Frame: Measured within one week of discharge form the NICU; post-discharge (4-8 weeks); 6 months postpartum; 12 months postpartum
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Score of financial hardships experienced during the NICU stay, including using up all savings, taking out loans, borrowing from friends, incurring debt, being threatened by eviction, or having a shut-off of an energy utility.
Scoring for each question is yes/no and is summed to create an overall score that ranges between 0 and 6.
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Measured within one week of discharge form the NICU; post-discharge (4-8 weeks); 6 months postpartum; 12 months postpartum
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Food insecurity
Time Frame: Measured biweekly from NICU admission to discharge or 42 weeks corrected gestational age, whichever comes earlier (maximum of 18 weeks); post-discharge (4-8 weeks); 6 months postpartum; 12 months postpartum
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Score of Food Insecurity Screening Tool; assesses the risk of food insecurity (availability and affordability) in households based on questions derived from the U.S. Household Food Security Survey Module.
Response options include: "Often True," "Sometimes True," "Never True".
An affirmative response on either item will be considered to be positive for food insecurity.
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Measured biweekly from NICU admission to discharge or 42 weeks corrected gestational age, whichever comes earlier (maximum of 18 weeks); post-discharge (4-8 weeks); 6 months postpartum; 12 months postpartum
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Housing instability
Time Frame: Measured within one week of discharge form the NICU; post-discharge (4-8 weeks); 6 months postpartum; 12 months postpartum
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Number of moves family has made since their child's birth.
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Measured within one week of discharge form the NICU; post-discharge (4-8 weeks); 6 months postpartum; 12 months postpartum
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Housing insecurity
Time Frame: Measured within one week of discharge form the NICU; post-discharge (4-8 weeks); 6 months postpartum; 12 months postpartum
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Score on housing insecurity scale; assesses participants' worry that they may not have stable housing in the next 2 months.
Likert scales ranging from 0 (not at all worried) to 3 (very worried).
Higher scores indicate greater levels of housing insecurity.
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Measured within one week of discharge form the NICU; post-discharge (4-8 weeks); 6 months postpartum; 12 months postpartum
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Transportation insecurity
Time Frame: Measured biweekly from NICU admission to discharge or 42 weeks corrected gestational age, whichever comes earlier (maximum of 18 weeks); post-discharge (4-8 weeks); 6 months postpartum; 12 months postpartum
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Score on transportation insecurity item; assesses participants' experience of transportation-related issues affecting their ability to visit the NICU.
Likert scales ranging from 0 (never) to 3 (always).
Higher scores indicate greater levels of transportation insecurity.
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Measured biweekly from NICU admission to discharge or 42 weeks corrected gestational age, whichever comes earlier (maximum of 18 weeks); post-discharge (4-8 weeks); 6 months postpartum; 12 months postpartum
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Mother emergency department visit post-discharge
Time Frame: Measured at post-discharge survey (4-8 weeks after infant discharge from NICU); 6 months postpartum; 12 months postpartum
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The number of emergency department visits by the mother in the postpartum period.
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Measured at post-discharge survey (4-8 weeks after infant discharge from NICU); 6 months postpartum; 12 months postpartum
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Baby emergency department visit weeks post-discharge
Time Frame: Measured at post-discharge survey (4-8 weeks after infant discharge from NICU); 6 months postpartum; 12 months postpartum
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The number of emergency department visits by the infant after discharge.
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Measured at post-discharge survey (4-8 weeks after infant discharge from NICU); 6 months postpartum; 12 months postpartum
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Life's Essential 8 (LE8) behavioral cardiovascular health score
Time Frame: Measured at pre-discharge; post-discharge (4-8 weeks, where all components are available); 6 months postpartum; 12 months postpartum
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Composite score (0-100) based on four behavioral components: diet quality, physical activity, sleep health, and nicotine exposure, scored according to American Heart Association Life's Essential 8 criteria.
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Measured at pre-discharge; post-discharge (4-8 weeks, where all components are available); 6 months postpartum; 12 months postpartum
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Primary care utilization in the postpartum period
Time Frame: Measured at post-discharge (4-8 weeks); 6 months postpartum; 12 months postpartum
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Number of visits with a primary care provider for routine or sick care.
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Measured at post-discharge (4-8 weeks); 6 months postpartum; 12 months postpartum
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Adherence to recommended care for chronic conditions
Time Frame: Measured at post-discharge (4-8 weeks); 6 months postpartum; 12 months postpartum
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Self-reported adherence to recommended postpartum care for chronic conditions (hypertension, diabetes, and mental health), including medication adherence and engagement with healthcare providers for condition management.
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Measured at post-discharge (4-8 weeks); 6 months postpartum; 12 months postpartum
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Collaborators and Investigators
Sponsor
Sponsor
Collaborators
Collaborators
Investigators
Investigators
- Principal Investigator: Margaret McConnell, PhD, Harvard School of Public Health (HSPH)
- Principal Investigator: Margaret Parker, MD, UMass Memorial Health
Publications and helpful links
Study record dates
Study Major Dates
Study Start (Actual)
Study Start
Primary Completion (Estimated)
Primary Completion
Study Completion (Estimated)
Study Completion
Study Registration Dates
First Submitted
First Submitted
First Submitted That Met QC Criteria
First Submitted That Met QC Criteria
First Posted (Actual)
First Posted
Study Record Updates
Last Update Posted (Actual)
Last Update Posted
Last Update Submitted That Met QC Criteria
Last Update Submitted That Met QC Criteria
Last Verified
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
Other Study ID Numbers
- Study00001150
- 1R01HD109293-01 (U.S. NIH Grant/Contract)
- 6-23FY-0012 (Other Grant/Funding Number: March of Dimes)
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
product manufactured in and exported from the U.S.
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