Insurance and early racial disparities in skin-to-skin care during NICU hospitalization.

OBJECTIVE: To evaluate sociodemographic disparities in parent engagement behaviors during neonatal intensive care unit (NICU) hospitalization. STUDY DESIGN: We conducted a retrospective cohort study of 656 infants admitted to a Level IV NICU. Weekly parent engagement behaviors, including skin-to-skin care (SCC), were obtained from nursing flowsheet data and linked to clinical and sociodemographic data. Mixed-effects negative binomial models evaluated associations with weekly engagement counts. RESULTS: Public insurance was associated with fewer weekly engagement events across most domains, including SSC (adjusted incidence rate ratio [aIRR] 0.39), holding (aIRR 0.62), participation in cares (aIRR 0.47) and bedside presence (aIRR 0.61) (all p < 0.001). Although race was not associated with SSC across hospitalization, Black infants received fewer SSC sessions during Weeks 1-2, compared to White infants. CONCLUSIONS: Insurance-related disparities in engagement persist throughout hospitalization, whereas racial disparities in SSC were concentrated early, suggesting early hospitalization as a critical window for equity-focused interventions.