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Impact of Optimized Breastfeeding on the Costs of Necrotizing Enterocolitis in Extremely Low Birthweight Infants
Tarah T Colaizy1, Melissa C Bartick2, Briana J Jegier3
1Carver College of Medicine, University of Iowa, Iowa City, IA.
Insights
Feeding extremely low birth weight (ELBW) infants human milk significantly reduces necrotizing enterocolitis (NEC) risk. Supporting maternal milk production can prevent infant deaths and lower healthcare costs associated with NEC.
Area of Science:
- Neonatalogy
- Pediatric Gastroenterology
- Clinical Nutrition
Background:
- Necrotizing enterocolitis (NEC) is a major cause of morbidity and mortality in extremely low birth weight (ELBW) infants.
- Feeding practices, including the use of preterm formula (PF) and maternal milk, significantly influence NEC risk.
- Suboptimal feeding strategies contribute to substantial healthcare costs and adverse outcomes in ELBW infants.
Purpose of the Study:
- To quantify the risk of NEC in ELBW infants based on varying levels of preterm formula and maternal milk intake.
- To calculate the economic and mortality impact of suboptimal feeding practices on NEC incidence in ELBW infants.
Main Methods:
- Utilized adjusted odds ratios (aORs) from the Glutamine Trial to simulate a cohort of ELBW infants.
- Employed Monte Carlo simulation to compare current suboptimal feeding practices with a theoretical scenario where 90% of infants receive at least 98% human milk.
- Analyzed NEC incidence, mortality, and associated direct medical, indirect nonmedical, and premature death costs.
Main Results:
- NEC incidence was 1.3% with ≥98% human milk, 11.1% with exclusive PF, and 8.2% with a mixed diet (P = .002).
- Exclusive PF (aOR = 12.1) and mixed diets (aOR = 8.7) were associated with significantly increased NEC risk compared to predominantly human milk.
- Current feeding practices were linked to 928 excess NEC cases and 121 excess deaths annually, with estimated suboptimal feeding costs of $27.1 million (direct medical) and $1.5 billion (premature death).
Conclusions:
- Not feeding ELBW infants predominantly human milk increases NEC risk.
- Interventions to promote maternal milk production in mothers of ELBW infants are crucial for preventing NEC-related infant mortality.
- Optimizing feeding strategies can lead to significant reductions in healthcare costs and improvements in survival rates for ELBW infants.
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.
