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Pediatric Research (2026)
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.
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.
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.
Cumulative NICU AHS availability was not associated with higher HM use. Structural presence of AHS alone may not reflect integration into effective feeding practices.
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.
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The data that support the findings of this study are derived from the California Perinatal Quality Care Collaborative (CPQCC) database. Due to data use agreements and protections for patient privacy, these data are not publicly available. De-identified data may be made available to qualified investigators upon reasonable request and subject to approval by CPQCC through a formal data request process. Information on data access requests can be found at https://www.cpqcc.org or by contacting CPQCC directly.
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We thank the California Perinatal Quality Care Collaborative (CPQCC) and its member hospitals for providing access to de-identified clinical data used in this study. We are deeply grateful to Dr. Jochen Profit for his mentorship and guidance throughout the conceptualization and analysis of this work.
This work was conducted under the mentorship of Dr. Jochen Profit, whose research program is supported by the National Institutes of Health (NIH) [grant number, R01MD01817302]. No direct financial support was received for this analysis.
Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Stanford University School of Medicine and Lucile Packard Children’s Hospital at Stanford, Palo Alto, CA, USA
Igbagbosanmi Olatunji & Jochen Profit
California Perinatal Quality Care Collaborative, Stanford University School of Medicine, Palo Alto, CA, USA
Jessica Liu & Jochen Profit
PubMed Google Scholar
PubMed Google Scholar
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Igbagbosanmi Olatunji conceptualized the study, contributed to data analysis and interpretation, and drafted the initial manuscript. Jessica Liu conducted the statistical analyses and contributed to data interpretation. Jochen Profit provided mentorship, conceptual guidance, and critical review of the manuscript for important intellectual content. All authors reviewed and approved the final version of the manuscript as submitted and agree to be accountable for all aspects of the work.
Correspondence to Igbagbosanmi Olatunji.
The authors declare no competing interests.
Patient consent was not required as this study used de-identified data from the California Perinatal Quality Care Collaborative (CPQCC) registry.
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Olatunji, I., Liu, J. & Profit, J. Allied health services availability and human milk nutrition among preterm infants. Pediatr Res (2026). https://doi.org/10.1038/s41390-026-04939-z
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DOI: https://doi.org/10.1038/s41390-026-04939-z
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Pediatric Research (Pediatr Res)
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