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  • Quality Improvement Article
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Implementing food insecurity screening in a level IV neonatal intensive care unit

Journal of Perinatology volume 43, pages 1183–1188 (2023)Cite this article

Subjects

Food insecurity (FI), the lack of appropriate types and amounts of food for an active, healthy life, impacts neighborhoods across the United States. Approximately 10.5% of U.S. households were reported to be food insecure in 2019 [1, 2]. The COVID-19 pandemic exacerbated this problem, resulting in a 20% increase in food insecure households, and some states in the U.S. South reporting more significant increases in the number of households with FI [3, 4]. Poorer and less educated communities traditionally have limited access to resources, compounded by social barriers including transportation problems, economic factors and difficulties with food options, all of which contribute to FI [5,6,7]. FI is especially correlated with food deserts, areas where residents have few options for securing affordable and healthy food [3, 7]. Government programs such as the Supplemental Nutrition Assistance Program (SNAP) and the Special Supplemental Program for Women, Infants and Children (WIC) can alleviate FI [8], yet eligible families often do not participate in these programs for a variety of reasons including logistic and emotional burdens associated with participation [9]. Identifying families in need of these resources remains a challenge due to the lack of clear guidelines on screening tool selection and implementation of screening programs [10].

FI is worse in households with children, an important finding as FI negatively affects children’s acute and chronic health outcomes including weight, immune function, and mental health, starting as early as birth [1, 6, 8, 11]. Although there is a critical need to identify FI, the Neonatal Intensive Care Unit (NICU) at our institution did not have a standardized screening process for the families of admitted neonates. The health care practitioners in our institution’s Pediatric Outpatient Clinic screen for FI during well child visits and thus, can identify FI in the families of NICU graduates after discharge. However, families who do not follow up with their primary care providers may be missed. In addition, we do not know if families are already experiencing FI during the index hospitalization. We, therefore, designed a Quality Improvement (QI) project to achieve a 95% screening rate for FI among families with a neonate admitted to the NICU at our institution within 6 months. At the onset of this project, there were no reports of FI screening in other NICUs to the best of our knowledge.

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Fig. 1: Key driver diagram.
Fig. 2: Food insecurity screening rate.
Fig. 3: Referral after positive screen.

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Acknowledgements

We thank McKeller Knox, MSW; Angela Puuri, MSW for their help with carrying out the project and Dmitry Tumin, PhD for helping with data analysis and reviewing the manuscript.

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Authors and Affiliations

  1. Brody School of Medicine at East Carolina University, Greenville, NC, USA

    Kevin Travia, John A. Kohler Sr. & Uduak S. Akpan

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  1. Kevin Travia
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Contributions

KT contributed to the conception and design of the project, collecting data, and drafting of the project manuscript. JAK contributed to the conception and design of the study; he helped draft the project manuscript and critically revise the manuscript for important intellectual content. USA contributed to the conception and design of the project; she helped draft the project manuscript and critically revise the manuscript for important intellectual content. All authors approved the final version of the manuscript and agree to be accountable for all aspects of the work.

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Correspondence to Kevin Travia.

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Travia, K., Kohler, J.A. & Akpan, U.S. Implementing food insecurity screening in a level IV neonatal intensive care unit. J Perinatol 43, 1183–1188 (2023). https://doi.org/10.1038/s41372-023-01709-1

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