Assessing Neonatal Transport, Health Outcomes, and Psychosocial Inequities Among Black, Very Preterm Infants and Their Families to Advance Health Equity: Protocol for a Mixed Methods Study.

Background: Despite medical advancements, preterm birth rates in the United States remain high and contribute substantially to infant mortality and long-term morbidity, with Black families disproportionately affected. Very preterm (VPT) infants-born between 24 and 30 weeks' gestation-are frequently delivered at community hospitals that lack advanced neonatal care and therefore require postnatal transport to tertiary neonatal intensive care units (NICUs). While neonatal transport is essential for optimizing infant outcomes, it can create additional challenges for families, including geographic separation from the NICU, disruptions to early parent-infant bonding, and increased parental psychosocial stress. These challenges may be further intensified by social vulnerability and experiences of perceived discrimination in health care settings. Objective: This study examines associations between neonatal transport, infant health outcomes, and the psychosocial well-being of Black parents with VPT infants. It also examines how structural inequities and social vulnerability shape experiences from delivery through NICU hospitalization. Methods: This protocol describes a longitudinal mixed methods multiple case study at a single perinatal center in South Carolina. Up to 10 cases of VPT Black infants transported from community hospitals between May 2023 and January 2024 are included. Each case includes the infant and mother, with partners invited. Quantitative data include infant outcomes from electronic medical records, neighborhood disadvantage using the Area Deprivation Index, and parent surveys of stress, anxiety, depression, bonding, perceived discrimination, and access to care. Qualitative data come from semistructured interviews guided by an adaptation of the National Institute on Minority Health and Health Disparities Research Framework and analyzed using reflexive thematic analysis. Data are integrated within each case to create structured summaries, followed by cross-case comparisons to identify patterns and variation. Results: The study was funded by the National Institute of Nursing Research in July 2023. Participant enrollment occurred between May 2023 and January 2024, with 6 cases enrolled. Data collection and electronic medical record abstraction were completed in May 2024, with analysis completed by July 2024. This manuscript reports the protocol and analytic plan. Detailed results will be reported in 2 companion manuscripts currently under review; publication of one is anticipated in fall 2026. Conclusions: This protocol outlines a novel mixed methods case study of neonatal transport and infant and parent outcomes among Black families. The study is exploratory and intended to generate hypotheses and inform future larger scale research and intervention development to support parental mental health, reduce disparities, and improve care experiences following preterm birth and neonatal transport.