Original ArticleImpact of Optimized Breastfeeding on the Costs of Necrotizing Enterocolitis in Extremely Low Birthweight Infants
Section snippets
Methods
We developed models of the medical and mortality costs of NEC under current and optimized (defined as 90% of infants receiving ≥98% human milk) feeding patterns, and calculated the savings achieved by an optimized diet.
We measured direct and indirect medical costs, indirect nonmedical costs (eg, parental travel), and cost because of death from NEC, following previous analyses.11, 12 These models assumed that all infants received human milk fortified with bovine-based fortifier and were
Results
Our sample from the Glutamine Trial included 848 ELBW infants, 650 of whom received at least some human milk and 198 of whom were fed exclusive PF. Among those infants receiving any human milk, 77 received ≥98% human milk (optimized), 573 received <98% human milk (mixed), and 198 received exclusive PF. Gestational age varied between diet groups, with the optimized group being 6 days less mature (optimal 253/7 weeks, mixed diet 262/7 weeks, PF 262/7 weeks; P = .003). The highest quintile of
Discussion
We found that ELBW infants fed diets containing exclusive PF faced markedly increased risk of NEC, compared with those fed ≥98% human milk. We were surprised to find no difference in NEC rates among infants fed exclusively PF and those who received a mixed diet containing <98% human milk. This suggests that mixed human milk and PF diets may not be as protective against NEC as complete human milk diets, however, we were not able to model mixed diets more precisely. Other investigators have found
References (44)
- et al.
Breast milk and neonatal necrotizing enterocolitis
Lancet
(1990) - et al.
The Rush Mothers' Milk Club: breastfeeding interventions for mothers with very-low-birth-weight infants
J Obstet Gynecol Neonatal Nurs
(2004) - et al.
Supporting breastfeeding in the neonatal intensive care unit: rush Mother's Milk Club as a case study of evidence-based care
Pediatr Clin North Am
(2013) Prevention of breastfeeding tragedies
Pediatr Clin North Am
(2001)- et al.
Cost of morbidities in very low birth weight infants
J Pediatr
(2013) - et al.
Economic benefits and costs of human milk feedings: a strategy to reduce the risk of prematurity-related morbidities in very-low-birth-weight infants
Adv Nutr
(2014) - et al.
Mortality and management of surgical necrotizing enterocolitis in very low birth weight neonates: a prospective cohort study
J Am Coll Surg
(2014) - et al.
Randomized trial of exclusive human milk versus preterm formula diets in extremely premature infants
J Pediatr
(2013) - et al.
An exclusively human milk-based diet is associated with a lower rate of necrotizing enterocolitis than a diet of human milk and bovine milk-based products
J Pediatr
(2010) - et al.
Benefits of maternal and donor human milk for premature infants
Early Hum Dev
(2006)
Feeding strategies for premature infants: beneficial outcomes of feeding fortified human milk versus preterm formula
Pediatrics
Randomized trial of donor human milk versus preterm formula as substitutes for mothers' own milk in the feeding of extremely premature infants
Pediatrics
Human milk versus formula feeding among preterm infants: short-term outcomes
Am J Perinatol
Early human milk feeding is associated with a lower risk of necrotizing enterocolitis in very low birth weight infants
J Perinatol
Role of human milk in extremely low birth weight infants' risk of necrotizing enterocolitis or death
J Perinatol
Beneficial effects of breast milk in the neonatal intensive care unit on the developmental outcome of extremely low birth weight infants at 18 months of age
Pediatrics
The institutional cost of acquiring 100 mL of human milk for very low birth weight infants in the neonatal intensive care unit
J Hum Lact
Positive effect of NICU admission on breastfeeding of preterm US infants in 2000 to 2003
J Perinatol
Quality indicators for human milk use in very low-birthweight infants: are we measuring what we should be measuring?
J Perinatol
The burden of suboptimal breastfeeding in the United States: a pediatric cost analysis
Pediatrics
Cost analysis of maternal disease associated with suboptimal breastfeeding
Obstet Gynecol
Parenteral glutamine supplementation does not reduce the risk of mortality or late-onset sepsis in extremely low birth weight infants
Pediatrics
Cited by (51)
Early neurodevelopmental follow-up in the NICHD neonatal research network: Advancing neonatal care and outcomes, opportunities for the future
2022, Seminars in PerinatologyCitation Excerpt :Enhancing mediators that improve outcomes is another potential interventional strategy. For example, early work done by the NRN Follow-up Study Group investigating effects of breast milk demonstrate not only medical benefit, but improvement in 2- and 3-year outcomes.44,86 Therefore, increasing breast milk nutrition for ELBWs is another strategic opportunity to improve long term outcomes.
Fortified Donor Human Milk Frequently Does Not Meet Sodium Recommendations for the Preterm Infant
2022, Journal of PediatricsPRIME (preterm infants need milk early) - Success of a multidisciplinary quality improvement project in a tertiary neonatal unit
2021, Journal of Neonatal NursingCitation Excerpt :Maternal milk (MM) is valuable for preterm infants and protects against necrotising enterocolitis (NEC), bronchopulmonary dysplasia (BPD), and other morbidities(Corpeleijn et al., 2012; Cortez et al., 2018; Meinzen-Derr et al., 2009; Patel et al., 2017). In addition to reduction in clinical pathology, increased MM intake among preterm infants in the neonatal intensive care unit (NICU) reduces direct and indirect medical costs (Colaizy et al., 2016; McCarthy et al., 2017), and is associated with improved long term neurodevelopmental outcomes(Horwood et al., 2001; Vohr et al., 2006, 2007). Although current guidelines for preterm infants advise the early initiation of enteral MM feeds as soon as possible after birth(Senterre, 2014; Snyder et al., 2017; Yu et al., 2019), many infants do not start feeds in the first 24 h as MM is not available(Kelly et al., 2018).
Endocrine disrupting chemicals and the mammary gland
2021, Advances in PharmacologyEssential and toxic elements in human milk concentrate with human milk lyophilizate: A preclinical study
2020, Environmental ResearchProbiotic Use and Safety in the Neonatal Intensive Care Unit: A Matched Cohort Study
2020, Journal of Pediatrics
Funded by W.K. Kellogg Foundation (P3024102) and the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD; U10 HD053109). NICHD and the National Center for Research Resources supported the Neonatal Research Network's Glutamine Trial through cooperative agreements [Appendix]). Participating sites collected data and transmitted it to RTI International, the data coordinating center for the network, which stored, managed, and analyzed the data for this study. Although NICHD staff did have input into the study design, conduct, analysis, and manuscript drafting, the content is solely the responsibility of the authors and does not necessarily represent the official views of NICHD. The authors declare no conflicts of interest.
- ∗
List of additional members of the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network is available at www.jpeds.com (Appendix).