Juggling Roles: A Study of Diverse Neonatal Intensive Care Unit Parents and Their Work-Family Transition

PROJECT SUMMARY / ABSTRACT Preterm infants are at a heightened risk for developing neuromotor, cognitive, and psychiatric disorders that persist through adulthood. Infants born very preterm (<32 weeks gestational age) are three times more likely to develop psychiatric disorders, including anxiety, ADHD, and autism compared to term infants. Critically, the consequences of prematurity disproportionately impact Black and low SES families. The overall high prevalence of prematurity, coupled with Black and low SES families’ increased risk, is a serious public health concern. However, the mechanisms contributing to these disparities are largely unexplored. Identifying modifiable mechanisms will help inform policies and practices that promote healthy neurodevelopment for preterm infants and their caregivers. Parenting premature infants is challenging due to the physical parent-infant separation in the neonatal intensive care unit (NICU). Extensive research has emphasized the important role of parents and parental involvement in the NICU to promote infant neurodevelopment. Yet we know little about the external contextual factors that impact and impede parent involvement, especially in diverse populations. A significant barrier to NICU involvement may be conflicting work and family demands. >62% of families with children include two working parents. Further, low-income families in particular return to paid work as soon as four weeks after childbirth which can have implications for their ability to visit the NICU. Regrettably there is virtually no research on NICU parents transition to parenthood from a work-family lens. The proposed study will use a unique method, Ecological Momentary Assessment (EMA), to monitor parents’ daily mental health, NICU involvement, and work/family demands during their infants’ NICU hospitalization in a racially and ethnically diverse sample of 250 families (defined as a mother, a secondary caregiver, and their infant). We aim to 1) examine stable and dynamic associations between work factors, NICU involvement, and caregiver mental health utilizing a longitudinal EMA burst design; and 2) examine how work, NICU involvement, and caregiver mental health are related to infant neurodevelopment. We hypothesize that caregivers with ideal work policies and conditions (e.g., shorter work hours, more job flexibility, more job autonomy, more paid leave) will have better mental health and more NICU involvement, which, in turn, will be associated with better infant neurodevelopmental outcomes at NICU discharge and 1-year follow-up. Additionally, given the differential NICU experience for Black and low SES families, we hypothesize that the associations between work, mental health, NICU involvement, and infant neurodevelopment will be exacerbated for Black and low SES families. Results from this study will address the important public health concern of prematurity in diverse families from a unique work-family lens that may help identify family-level and state/federal policy-level intervention targets to support parent NICU involvement and mitigate the long-term neurodevelopmental consequences of prematurity.