Neonatal transport, health outcomes, and psychosocial inequities among Black very preterm infants and their families: Protocol for a mixed-methods study to advance health equity (Preprint)

BACKGROUND Despite medical advancements, preterm birth remains alarmingly high in the United States, contributing significantly to infant mortality and long-term health challenges. Black families are disproportionately affected by these high rates. Very preterm (VPT) infants- those born between 24 and 30 weeks' of gestation- are often delivered at community hospitals that lack specialized neonatal care. These infants require transport to tertiary-level NICUs, which can open the door for complications. In addition to medical complications, neonatal transport can create stress for families and affect parent-infant bonding during a crucial time. These problems are intensified by social vulnerability and perceived discrimination. OBJECTIVE This study examines how neonatal transport affects both infant health outcomes and the psychosocial health of Black parents with VPT infants. It explores how structural inequities, and social vulnerability can shape parental experiences- from delivery and transport to NICU hospitalization. METHODS Using a longitudinal, multiple-case study design with mixed methods, this research follows 10 cases of VPT Black infants transported from community hospitals in South Carolina between May 2023 and June 2024. Each case includes the infant and mother (with an invitation for partners to participate). Quantitative data includes infant health outcomes extracted from electronic medical records and neighborhood disadvantage assessed using the Area Deprivation Index. Parents complete validated surveys measuring stress, anxiety, depression, bonding, discrimination and access. Qualitative data comes from semi-structured interview guides based on an adaptation of the NIMHD Research Framework. Reflexive thematic analysis is used for to analyze these interviews. Data are integrated within and across cases to create detailed case summaries and cross-case comparisons. RESULTS The study received National Institute of Nursing funding in July 2023. This protocol describes only the methods and the analytical approach. In accordance with our grant award, research results will be reported and disseminated through peer-reviewed publications and conferences. CONCLUSIONS This study is the first to explore the overlapping intersections of neonatal transport, infant outcomes, and psychosocial health in Black parents using a mixed-methods case study approach. The findings aim to inform future interventions that reduce disparities, improve parents' experiences, and promote better outcomes for both infants and maternal mental health.