Financial Support to Medicaid-Eligible Mothers Increases Caregiving for Preterm Infants

Objectives To assess the impact of financial support on maternal caregiving activities for preterm infants. Methods We conducted a small randomized controlled trial (RCT) in two Massachusetts Neonatal Intensive Care Units (NICUs). We enrolled 46 Medicaid-eligible mothers of preterm infants between January 2017 and June 2018 and randomly assigned them to a treatment group (up to 3 weekly financial transfers of $200 each while their infant was in the hospital) or a control group. We collected hospital-record data while the infant was admitted. The primary outcome was a binary variable indicating skin-to-skin care (STSC) was provided during a hospital day. Secondary outcomes included daily maternal visitation, daily provision of breastmilk, neonatal growth and length of stay (LOS). Multilevel generalized linear models with random effects were used to estimate treatment effects on daily maternal behaviors and ordinary least squares models were used to estimate impacts on neonatal growth and LOS. Results We assigned 25 women to the intervention and 21 to the control and observed them over 703 days of their infants’ hospitalization. Mothers who received financial support were more likely to provide STSC (adjusted risk ratio: 1.85; 95% confidence interval [CI] 1.31–2.62) and breastmilk (adjusted risk ratio: 1.36; 95% CI 1.06–1.75) while their infant was in the NICU. We see no statistically significant impact on neonatal growth outcomes or LOS, though estimated confidence intervals are imprecise. Conclusions Our evidence demonstrates the potential for financial support to increase mothers' engagement with caregiving behaviors for preterm infants during the NICU stay.