Fellow, Neonatal-Perinatal Medicine Childrens Hospital of Philadelphia Philadelphia, Pennsylvania, United States
Background: Poverty is associated with adverse outcomes in preterm infants and their caregivers. Monthly unconditional cash transfers (UCTs) – no-strings-attached payments – may be an effective intervention to reduce poverty and financial stress and improve child health outcomes. The impact of UCTs among low-income preterm infants and their caregivers remains unknown. Objective: To determine the feasibility and acceptability of randomizing high-value ($325/month) and low-value ($25/month) UCTs to 24 low-income preterm infants and their caregivers beginning in the first month of life and continuing for a 4-month period and examine associations of UCTs with breastfeeding rates at 4 months. Design/Methods: We are performing a pilot RCT in a level III NICU in Philadelphia designed to inform a future larger trial. We are recruiting eligible caregivers within 2 weeks of birth of their preterm infant (22 to < 37 weeks’ GA). Caregiver eligibility criteria include Medicaid eligibility, age ≥18 years, English or Spanish fluency, residency in Philadelphia, not being “highly likely” to move out of state in the next year, and no plans to place the infant for adoption. The trial was approved by the University of Pennsylvania IRB and pre-registered.
Caregivers are randomized to high- versus low-value UCTs in a 1:1 fashion. Monthly UCTs are distributed via a debit card over a 4-month period. Data are collected via surveys at baseline, 2 months, and 4 months and semi-structured interviews at 4 months. Survey questions relate to demographics, infant and caregiver health, breastfeeding, and acceptability. Interviews examine caregivers’ lived experiences. We define feasibility as enrolling >60% of eligible caregivers and < 20% attrition rate for the surveys. We define acceptability as >90% of caregivers reporting “agree” or “strongly agree” to each of the 4 items on the validated Acceptability of Intervention measure.
To date, we have enrolled 17 of 24 caregivers. Enrollment will be complete by December 2023 and quantitative and qualitative data collection and analysis will be complete by March 2024.
