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J Pediatr. 2016 Aug;175:100-105.e2. doi: 10.1016/j.jpeds.2016.03.040. Epub 2016 Apr 27.

Impact of Optimized Breastfeeding on the Costs of Necrotizing Enterocolitis in Extremely Low Birthweight Infants.

Author information

1
Carver College of Medicine, University of Iowa, Iowa City, IA. Electronic address: tarah-colaizy@uiowa.edu.
2
Department of Medicine, Cambridge Health Alliance and Harvard Medical School, Cambridge, MA.
3
D'Youville College, Buffalo, NY.
4
Department of Industrial Engineering, University of Pittsburgh, Pittsburgh, PA.
5
Alliance for the Prudent Use of Antibiotics, Boston, MA.
6
Department of Computational and Applied Mathematics, Rice University, Houston, TX.
7
Department of Pediatrics, University of Pittsburgh, Pittsburgh, PA.
8
Department of Medicine, University of California, Davis, Davis, CA.
9
Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, NC; Carolina Global Breastfeeding Institute, Gillings School of Global Public Health, Chapel Hill, NC.

Abstract

OBJECTIVE:

To estimate risk of necrotizing enterocolitis (NEC) for extremely low birth weight (ELBW) infants as a function of preterm formula (PF) and maternal milk intake and calculate the impact of suboptimal feeding on the incidence and costs of NEC.

STUDY DESIGN:

We used aORs derived from the Glutamine Trial to perform Monte Carlo simulation of a cohort of ELBW infants under current suboptimal feeding practices, compared with a theoretical cohort in which 90% of infants received at least 98% human milk.

RESULTS:

NEC incidence among infants receiving ≥98% human milk was 1.3%; 11.1% among infants fed only PF; and 8.2% among infants fed a mixed diet (P = .002). In adjusted models, compared with infants fed predominantly human milk, we found an increased risk of NEC associated with exclusive PF (aOR = 12.1, 95% CI 1.5, 94.2), or a mixed diet (aOR 8.7, 95% CI 1.2-65.2). In Monte Carlo simulation, current feeding of ELBW infants was associated with 928 excess NEC cases and 121 excess deaths annually, compared with a model in which 90% of infants received ≥98% human milk. These models estimated an annual cost of suboptimal feeding of ELBW infants of $27.1 million (CI $24 million, $30.4 million) in direct medical costs, $563 655 (CI $476 191, $599 069) in indirect nonmedical costs, and $1.5 billion (CI $1.3 billion, $1.6 billion) in cost attributable to premature death.

CONCLUSIONS:

Among ELBW infants, not being fed predominantly human milk is associated with an increased risk of NEC. Efforts to support milk production by mothers of ELBW infants may prevent infant deaths and reduce costs.

KEYWORDS:

economic analysis; human milk; monte carlo modeling; necrotizing enterocolitis

PMID:
27131403
PMCID:
PMC5274635
DOI:
10.1016/j.jpeds.2016.03.040
[Indexed for MEDLINE]
Free PMC Article

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