Congratulations to C3EN Administrative Core co-director Tricia Johnson, Professor of Health Systems Management at Rush University, and Multi-PI Aloka Patel, Glore Family Professor of Neonatology at Rush University, on receiving a third NIH R01 grant in support of their ReDiMOM (Reducing Disparity in Receipt of Mother’s Own Milk) study!
About 1.6% of babies are born very preterm— before 32 weeks of pregnancy — and spend an average of 10 weeks in a neonatal intensive care unit (NICU). These infants face immediate health challenges, as well as long-term risks for chronic conditions like asthma, high blood pressure, cognitive delays, and behavioral disorders. Receiving breast milk has been shown to reduce serious complications in infants, including necrotizing enterocolitis, sepsis, and retinopathy of prematurity–and reduce the risk of breast and ovarian cancer in mothers who provide their breast milk.
Despite these benefits, many preterm babies are fed with formula or do not receive breast milk long enough to experience all the benefits. “Donor milk has been shown to reduce some serious complications in very premature infants — but those benefits are most significant in the early weeks, up to around 36 weeks gestational age. After that, the benefit is less clear, and hospitals often transition to formula unless the mother is providing milk,” says Johnson.
The cost of providing breast milk to hospitalized babies may also pose a barrier for many mothers. In an earlier study, Patel and colleagues found that Hispanic and non-Hispanic white mothers had fairly similar rates of going home on breast milk, but the rate for Black mothers was about half. “While 43% of non-Black babies went home on mother’s milk, only about 23% of babies born to Black mothers did,” explains Johnson. “Once babies leave the NICU without receiving their mother’s own milk, or MOM, it’s very unlikely they’ll get breast milk afterward. The strongest predictor of not going home on mother’s milk was eligibility for WIC”–the Supplemental Nutrition Assistance Program for Women, Infants, and Children program, which provides food assistance to low-income pregnant women, infants, and children.
Providing breast milk in the NICU can incur significant costs for families who must take the time to pump milk and then transport the pumped milk from their homes to the hospital. Some families are unable to visit the NICU daily due to work, childcare, or transportation issues. Furthermore, access to hospital-grade breast pumps — which are critical for mothers who deliver very early and are completely pump-dependent — is often limited.
“Once we saw that, we started thinking: how do we intervene to support mothers in providing breast milk in the NICU, especially when we now know that poverty is a major barrier?” says Johnson.
The RediMOM intervention thus takes a unique approach: a conditional cash transfer that provides financial support to mothers who pump breast milk, acknowledging the time and effort it takes. Participating mothers receive a hospital-grade breast pump to use for the duration of the study. A courier delivers the milk from their home to the hospital. And mothers are compensated at the Illinois minimum wage rate for the estimated two hours they spend pumping: $30 per day, or $210 per week. Unlike the poverty reduction study Baby’s First Years, which gave unconditional financial support to families and resulted in negligible improvements in child health, this intervention incentivizes increasing MOM provision with the hope of producing measurable health benefits.
A key component of the ReDiMOM intervention includes sustainability–but if the benefits are demonstrable, the savings could be enormous for hospitals and insurers. “One day in the NICU can be several thousand dollars. If the intervention saves just one or two days, it could pay for itself,” says Johnson. “Complications like necrotizing enterocolitis or bronchopulmonary dysplasia cost about $50,000 to manage. Sepsis costs around $30,000 when you factor in extra NICU days and treatments.” With recent shifts in hospital payment models with the adoption of Diagnosis-Related Group (DRG) payments for NICU stays, hospitals are now reimbursed a lump sum per case based on diagnostic categories rather than a fee for each service. That means reducing complications and lengths of stay can directly improve a hospital’s bottom line.
Johnson and Patel are currently enrolling the first cohort of about 180 mothers in the study. With the new NIH funding, they will be able to follow the original cohort of children through preschool age (4-6 years old), evaluating a wide range of health indicators, including cardiometabolic outcomes, growth and weight, cognitive development, costs of medical and developmental services, and rates of autism and behavioral disorders. They will also track metrics like emergency room visits, hospitalizations, and whether children need additional physical, occupational, speech, or developmental therapy, with the goal of not only understanding short term impacts but how early access to MOM might influence lifelong health trajectories and medical care costs.
Studying such a cohort for this length of time is a unique opportunity, not only for the ReDiMOM intervention but for understanding how preterm birth affects lifelong health. “Most preterm infants get routine follow-up for two years, but after that, they often transition to a general pediatrician and are essentially lost to research. We don’t have good data beyond that point,” says Patel. “Now, in addition to the cardiometabolic and cost outcomes, we’re also doing cognitive assessments, screening for autism, and evaluating other higher-risk conditions in preterm infants. Observational studies suggest breast milk may reduce some of these risks, but we don’t have solid data, especially with long-term tracking.” Their work may also offer insight into contemporary diagnoses. “Autism wasn’t widely diagnosed 15–20 years ago, so it wasn’t even considered a research outcome in older studies,” she adds.
Johnson and Patel expect results from the first phase of the study, which tracks MOM provision at NICU discharge, by spring 2026, with longer-term findings continuing through 2031 and beyond. “We ultimately want to follow both children and mothers well into adulthood, with a broader goal of reducing the incidence of chronic conditions,” says Patel. “Preterm infants are at higher risk for chronic diseases later in life—high blood pressure, abnormal heart formation, asthma, behavioral issues, autism, and cognitive delays. Getting out of the NICU isn’t the end of the story. Most babies do well, but the population as a whole remains at higher risk. If we can support interventions that even modestly reduce these risks, the impact could be huge. We’d be helping program long-term health right from birth.”
“We also have a pilot study collecting cardiometabolic indicators for the mothers,” adds Johnson.“ Some cross-sectional data suggest breastfeeding improves maternal cardiometabolic health. The research team is starting to gather longitudinal data from mothers enrolled in ReDiMOM, with pilot funds from a philanthropic donor to Rush University’s College of Health Sciences. It’s still a pilot, but it lays the groundwork for future research. “Benefits often take decades to show up, which is why this kind of long-term research is so rare and so important.”