Financial Support for Mothers of Premature Infants

Recruiting at 3 trial locations

Overseen By Margaret McConnell, PhD

Age: 18+

Sex: Female

Trial Phase: Academic

Sponsor: Harvard School of Public Health (HSPH)

Disqualifiers: Non-English/Spanish speaking, Non-resident, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: Unknown

420 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial explores whether financial support for low-income mothers can help them spend more time with their premature infants in the NICU. The goal is to determine if financial assistance reduces stress and encourages mothers to engage more in caregiving activities like breastfeeding and skin-to-skin contact, which are crucial for the baby's health and development. Mothers eligible for this trial have Medicaid insurance and a baby born between 24 and 34 weeks at specific hospitals in Massachusetts or Georgia. As an unphased trial, this study provides a unique opportunity for mothers to contribute to research that could enhance support systems for families in similar situations.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications.

What prior data suggests that financial transfers are safe for mothers of premature infants?

Research has shown that financial help, such as cash transfers, can reduce stress for mothers of premature babies. This support facilitates visits to the NICU and enhances their ability to care for their babies. Studies have found that families receiving financial aid often worry less about healthcare costs. Since this assistance doesn't involve medication or medical procedures, it typically carries no physical risks. The aim is to alleviate financial stress, enabling mothers to better care for their children. To date, no safety issues have been reported with this type of financial support. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about this trial because it explores the impact of financial support as a unique approach to assist mothers of premature infants. Unlike traditional neonatal care that focuses on medical interventions for the infant, this approach addresses the socio-economic challenges faced by mothers, potentially enhancing their ability to spend more time with their infants in the NICU. By providing $160 weekly through a "CuddleCard" debit card, the trial aims to determine if financial transfers can improve maternal involvement and, consequently, infant outcomes. This innovative strategy shifts the focus from direct medical treatment to supporting the caregivers, potentially leading to holistic benefits for both mothers and their babies.

What evidence suggests that financial transfers are effective for increasing maternal caregiving in the NICU?

Research has shown that financial support for low-income mothers can improve the health of preterm babies. A review of 86 studies found that financial help is linked to better health for both mothers and their babies. In this trial, some mothers will receive financial transfers of $160 per week on a "CuddleCard" debit card, enabling them to spend more time visiting and caring for their infants in the NICU. Cash assistance can alleviate financial stress, allowing mothers to spend more time in the hospital with their newborns. This extra time helps mothers breastfeed and hold their babies skin-to-skin, both of which are crucial for the baby's health and growth. These findings suggest that financial support could help reduce health disparities seen in preterm babies from low-income families. ^{2 3 5 6 7}

Who Is on the Research Team?

Margaret Parker, MD

Principal Investigator

UMass Memorial Health

Margaret McConnell, PhD

Principal Investigator

Harvard School of Public Health (HSPH)

Are You a Good Fit for This Trial?

This trial is for low-income mothers with Medicaid who have given birth to preterm infants (24-33 weeks' gestation) at specific hospitals in Massachusetts and Georgia. The study aims to help these mothers spend more time in the NICU with their babies by providing financial support.

Inclusion Criteria

Mother is eligible for Medicaid insurance

Has an infant or infants born 24-33 weeks gestation

Mother is eligible to breastfeed (per hospital criteria)

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Intervention

Mothers in the intervention group receive weekly financial transfers to support NICU visits and caregiving activities

Up to 18 weeks

Weekly visits (in-person)

Follow-up

Participants are monitored for outcomes such as maternal caregiving behaviors and infant health post-discharge

4-8 weeks

Post-discharge survey and follow-up visits

What Are the Treatments Tested in This Trial?

Interventions

• Financial Transfers

Trial Overview The trial is testing if weekly financial transfers can increase visits to the NICU, reduce mothers' financial stress, and improve caregiving behaviors that benefit preterm infant health and development. It's a randomized controlled trial comparing usual care plus money versus just usual care.

How Is the Trial Designed?

Group I: Financial Transfers Experimental Treatment 1 Intervention

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.

Group II: Usual Care Active Control 1 Intervention

Who Is Running the Clinical Trial?

Harvard School of Public Health (HSPH)

Lead Sponsor

Trials

283

Recruited

17,030,000+

University of Massachusetts, Worcester

Lead Sponsor

Trials

372

Recruited

998,000+

Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)

Collaborator

Trials

2,103

Recruited

2,760,000+

Published Research Related to This Trial

An experimental study tested four methods for assessing blood flow in microvascular free tissue transfers, highlighting the importance of accurate monitoring during and after surgery.

The successful use of ultrasound Doppler and laser Doppler flowmeters in clinical settings has improved the reliability of microvascular reconstructions and simplified postoperative management.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Predicting the fate of free tissue transfers. Jones, BM.[2018]

A Doppler color-flow imager is an effective non-invasive tool for assessing blood flow and vascular patency in vascularized free fibula transfers, which can be challenging to evaluate.

This imaging technique can be utilized in the operating room, immediately after surgery, and for long-term follow-up, providing a permanent record of vascular anatomy and flow characteristics.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Vascular patency of fibular free graft: assessment by Doppler color-flow imager: a case report. Stevenson, TR., Rubin, JM., Herzenberg, JE.[2016]

Using laser Doppler flowmetry to monitor flap perfusion can help identify at-risk flaps during reconstruction after modified radical mastectomy, potentially preventing necrosis.

In a study of 16 consecutive transverse rectus abdominis myocutaneous flaps, two flaps were identified as at risk for major loss, but after microvascular interventions, all flaps survived successfully.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Assessment of TRAM flap perfusion using laser Doppler flowmetry: an adjunct to microvascular augmentation. Hallock, GG., Altobelli, JA.[2019]

Color flow Doppler ultrasound is an effective monitoring technique for detecting venous and arterial insufficiency in microvascular surgery, showing sensitivity to flow rates as low as 3.0 ml/min in an experimental swine model.

In a clinical study involving 25 postoperative patients, color flow ultrasound successfully visualized microvascular conduits and predicted insufficiency before occlusion, demonstrating its potential for improving patient outcomes in plastic and reconstructive surgery.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Color flow ultrasound for delineating microsurgical vessels: a clinical and experimental study. Amerhauser, A., Moelleken, BR., Mathes, SJ., et al.[2019]

An individualized psychosocial parental support (PPS) program for parents of extremely low-birth-weight (ELBW) infants was associated with a significant reduction in the length of hospital stay (LOS), with the PPS group averaging 86 days compared to 99 days for the control group.

The study involved 41 ELBW infants, and while the PPS program showed benefits in reducing LOS, no other significant differences in short-term neonatal outcomes were observed, indicating the need for further research to confirm these findings.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Psychosocial parental support programs and short-term clinical outcomes in extremely low-birth-weight infants. Nearing, GB., Salas, AA., Granado-Villar, D., et al.[2011]

The COPE program significantly reduced parental stress for parents of infants in the neonatal intensive care unit, as shown in a study with 49 parent sets (29 in the intervention group and 20 in the comparison group).

While there was no significant difference in parental depression scores or length of hospital stay, trends indicated that parents in the COPE group had lower depression scores and both groups reported over 95% satisfaction with care.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effect of a Parent Empowerment Program on Parental Stress, Satisfaction, and Length of Stay in the Neonatal Intensive Care Unit. Nieves, H., Clements-Hickman, A., Davies, CC.[2021]

Near-infrared spectroscopy (NIRS) and implantable Doppler (ID) devices have shown extremely high sensitivity (99.36% for NIRS and 100% for ID) in detecting failures of free tissue transfer (FTT) in reconstructive breast surgery, making them highly effective monitoring tools.

Both NIRS and ID significantly reduce FTT failure rates compared to conventional clinical assessment (CCA), indicating that these technologies not only improve patient outcomes but also potentially lower healthcare costs and reduce the workload for clinical staff.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Use of Near-infrared Spectroscopy and Implantable Doppler for Postoperative Monitoring of Free Tissue Transfer for Breast Reconstruction: A Systematic Review and Meta-analysis. Berthelot, M., Ashcroft, J., Boshier, P., et al.[2022]

A new program was developed where hospital nurses provide follow-up care to new mothers and their infants at home, addressing the gap in support after early hospital discharge.

The study compares health care costs between mother-infant pairs receiving this home care service and those who did not, highlighting the potential financial benefits of providing additional support during the postpartum period.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Enhancing early discharge with home follow-up: a pilot project. Brown, SG., Johnson, BT.[2019]

The COPE program significantly reduced anxiety and stress levels in Iranian mothers of premature infants in NICUs, with results showing improvement after each phase of the program (P < 0.001).

Mothers who participated in the COPE program were more actively involved in their infants' care compared to those in the control group, indicating that educational and behavioral support can enhance maternal participation and psychological well-being.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The effect of Creating Opportunities for Parent Empowerment program on maternal stress, anxiety, and participation in NICU wards in Iran. Mianaei, SJ., Karahroudy, FA., Rassouli, M., et al.[2022]

Financial support significantly increased maternal engagement in caregiving activities, with mothers receiving financial assistance being 85% more likely to provide skin-to-skin care and 36% more likely to provide breastmilk for their preterm infants in the NICU.

The study involved 46 Medicaid-eligible mothers and observed their behaviors over 703 days, but while financial support improved caregiving, it did not show a significant impact on neonatal growth or length of stay in the hospital.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Financial Support to Medicaid-Eligible Mothers Increases Caregiving for Preterm Infants. Andrews, KG., Martin, MW., Shenberger, E., et al.[2020]

Citations

1. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC11650771/

Financial incentives for family members of hospitalized ... A systematic review of 86 studies on financial assistance, used to improve maternal and infant health outcomes in low‐ to middle‐income ...

2. nature.com nature.com/articles/s41372-025-02293-2

Unconditional cash transfers to low-income preterm infants ... Cash transfers may reduce financial stress, allowing birthing parents to access needed preventative care. Cash transfers may also reduce ...

3. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC10768437/

Unconditional cash transfers for preterm neonates UCTs hold the potential to act as an instrument to decrease disparities in health outcomes of preterm infants, financial outcomes of their ...

4. bmcpediatr.biomedcentral.com bmcpediatr.biomedcentral.com/articles/10.1186/s12887-025-05621-9

CuddleCard: Protocol for a randomized controlled trial ... This randomized controlled trial aims to evaluate the effectiveness of financial transfers in promoting maternal caregiving behaviors.

5. clinicaltrials.gov clinicaltrials.gov/study/NCT03013660

NCT03013660 | Supporting Mothers of Preterm Infants This study aims to provide more evidence to determine whether removing these financial barriers has the potential to mitigate the poor outcomes of preterm ...

6. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC12326556/

Unconditional cash transfers to low-income preterm infants ... Cash transfers may reduce financial stress, allowing birthing parents to access needed preventative care. Cash transfers may also reduce ...

7. nature.com nature.com/articles/s41372-021-01213-4

The financial burden experienced by families of preterm ... Sixty percent of participants who received SSI reported “never” being worried about healthcare costs vs. only 31% of those who did not receive ...