P1.185: Availability of Allied Health Services and Human Milk Nutrition Disparities Across California

Background: Despite the benefits of human milk (HM) nutrition in very low birth weight (VLBW) infants, disparities persist in its use. Significant inequities in quality and outcomes of care also exist across safety net (sn) neonatal intensive care units (NICUs) and non-sn NICUs. Whether the availability of allied health services (AHS) across sn and non-sn NICUs contributes to disparate rates of HM nutrition among VLBW infants is unknown. The objective of this study was to assess the distribution of AHS across sn and non-sn NICUs in California and examine its association with rates of HM nutrition at discharge among VLBW infants.

Methods: Data was obtained from the statewide California Perinatal Quality Care Collaborative (CPQCC) data registry and the annual VON NICU survey, and included infants born at < 29 weeks gestational age (GA) or with birth weight (BW) < 1500 grams, from 2022–2023. We excluded infants who died in the delivery room and those with severe congenital anomalies. Sn NICUs included NICUs serving >66% Medi-Cal insurance coverage and >15 VLBW infants annually. We assessed the effects of AHS availability as well as multi-level factors (hospital/infant/maternal) on HM use at discharge in multivariate models. AHS included NICU-specific or shared-service lactation consultant, occupational therapist, physical therapist, social worker, and psychologist.

Results: There were 48/138 (35%) sn NICUs and 6177/9567 (64%) VLBW infants were discharged home. We found no significant differences in the availability of AHS across sn and non-sn NICUs. 97.9% of sn and 96.2% of non-sn hospitals indicated the presence of a lactation consultant. Availability of social worker was equal across both hospital types. Hierarchical regression analyses did not reveal a significant association between individual availability of any AHS and the NICUs rate of HM nutrition at discharge [Table 1]. However, a higher cumulative total number of available AHS was associated with increased rates of HM nutrition at home discharge [Table 1]. Rates of HM use at discharge were higher in non-sn NICUs (70.2 vs. 63.1 (p <.001)) [Table 2]. Infant factors associated with higher HM use at discharge included BW 1251–1500 grams, GA ≥ 27 weeks and 5-minute Apgar score ≥ 7 (p <.001) [Table 2]. Maternal factors including Asian race and receipt of prenatal care were associated with higher rates of HM use at discharge while Black race was associated with the least rates of HM use at discharge (p <.001) [Table 2].

Conclusion: We found no disparate availability of AHS between sn and non-snNICUs. Availability of a higher cumulative total number of AHS available was associated with increased use of HM at discharge home among VLBW infants.