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Background <p>Structural inequities in neonatal care may influence human milk (HM) feeding outcomes. We examined whether allied health service (AHS) availability differs between safety-net (sn) and non-snNICUs and its association with HM use at discharge among very low birth weight (VLBW) infants.</p> Methods <p>Population-based cohort study of California Perinatal Quality Care Collaborative (CPQCC) data (2022–2023) for infants born &lt;29 weeks’ gestation or &lt;1500 g birth weight (BW). Multivariable models assessed associations between AHS availability (lactation, occupational/physical therapy, social work, psychology) and HM use at discharge, adjusting for infant, maternal, and hospital factors.</p> Results <p>Among 138 NICUs, 35% were snNICUs; 64% of VLBW infants were discharged home. AHS availability did not differ between sn and non-snNICUs. Individual AHS availability was not associated with increased HM use, while greater cumulative AHS availability was associated with lower HM use. HM use at discharge was higher in non-snNICUs (70.2% vs. 63.1%, <i>p</i> &lt; 0.001). Higher infant gestation, BW, Apgar score, maternal Asian race, absence of infection and prenatal care were positive predictors; maternal Black and Hispanic race were negative predictors.</p> Conclusions <p>Cumulative NICU AHS availability was not associated with higher HM use. Structural presence of AHS alone may not reflect integration into effective feeding practices.</p> Impact <p><UnorderedList Mark="Bullet"> <ItemContent> <p>This statewide analysis examined relationships between allied health service (AHS) availability and human milk (HM) nutrition among preterm infants in California NICUs.</p> </ItemContent> <ItemContent> <p>Contrary to expectations, AHS availability did not differ between safety-net and non–safety-net hospitals.</p> </ItemContent> <ItemContent> <p>Individual AHS availability showed no association with HM use at discharge, while greater cumulative AHS availability correlated with lower HM use.</p> </ItemContent> <ItemContent> <p>Findings challenge assumptions that more AHS automatically improves HM outcomes and highlight the need to evaluate how allied health resources are integrated, coordinated, and aligned with family-centered lactation support in the NICU.</p> </ItemContent> </UnorderedList></p>

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Allied health services availability and human milk nutrition among preterm infants

  • 期刊论文

  • 发表日期：

    2026年5月1日

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  • Igbagbosanmi Olatunji,
  • Jessica Liu,
  • Jochen Profit

摘要

Background

Structural inequities in neonatal care may influence human milk (HM) feeding outcomes. We examined whether allied health service (AHS) availability differs between safety-net (sn) and non-snNICUs and its association with HM use at discharge among very low birth weight (VLBW) infants.

Methods

Population-based cohort study of California Perinatal Quality Care Collaborative (CPQCC) data (2022–2023) for infants born <29 weeks’ gestation or <1500 g birth weight (BW). Multivariable models assessed associations between AHS availability (lactation, occupational/physical therapy, social work, psychology) and HM use at discharge, adjusting for infant, maternal, and hospital factors.

Results

Among 138 NICUs, 35% were snNICUs; 64% of VLBW infants were discharged home. AHS availability did not differ between sn and non-snNICUs. Individual AHS availability was not associated with increased HM use, while greater cumulative AHS availability was associated with lower HM use. HM use at discharge was higher in non-snNICUs (70.2% vs. 63.1%, p < 0.001). Higher infant gestation, BW, Apgar score, maternal Asian race, absence of infection and prenatal care were positive predictors; maternal Black and Hispanic race were negative predictors.

Conclusions

Cumulative NICU AHS availability was not associated with higher HM use. Structural presence of AHS alone may not reflect integration into effective feeding practices.

Impact

This statewide analysis examined relationships between allied health service (AHS) availability and human milk (HM) nutrition among preterm infants in California NICUs.

Contrary to expectations, AHS availability did not differ between safety-net and non–safety-net hospitals.

Individual AHS availability showed no association with HM use at discharge, while greater cumulative AHS availability correlated with lower HM use.

Findings challenge assumptions that more AHS automatically improves HM outcomes and highlight the need to evaluate how allied health resources are integrated, coordinated, and aligned with family-centered lactation support in the NICU.