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Rates of Comorbidities in Very Low Birth Weight Infants Fed an Exclusive Human Milk Diet Versus a Bovine Supplemented
Jennifer Hanford1, Kimberly Mannebach1, Adrienne Ohler1
1Division of Neonatology, Department of Child Health, Women's and Children's Hospital, University of Missouri Health Care, Columbia, Missouri, USA.
Insights
An exclusive human milk diet (EHD) in NICU settings significantly reduced severe retinopathy of prematurity (ROP) and late-onset sepsis in preterm infants. While direct costs showed a small increase, long-term benefits and reduced co-morbidities suggest overall value.
Area of Science:
- Neonatal Medicine
- Pediatric Nutrition
- Health Economics
Background:
- Preterm infants face significant co-morbidities, impacting long-term health and healthcare costs.
- Exclusive human milk diet (EHD) is recognized for its benefits, but its impact on severe co-morbidities and cost-effectiveness requires further investigation.
- Neonatal intensive care units (NICUs) are exploring EHD to improve outcomes for vulnerable preterm populations.
Purpose of the Study:
- To evaluate the effect of an exclusive human milk diet (EHD) on severe co-morbidities in preterm infants.
- To assess the potential cost-savings associated with reduced co-morbidities resulting from EHD implementation.
- To analyze the statistical decrease in specific co-morbidities such as length of stay (LOS), total parenteral nutrition (TPN) duration, late-onset sepsis, necrotizing enterocolitis (NEC), bronchopulmonary dysplasia (BPD), and severe retinopathy of prematurity (ROP).
Main Methods:
- Retrospective cohort study design.
- Implementation of an exclusive human milk diet (EHD) in a level III NICU.
- Statistical analysis of co-morbidity rates and cost-effectiveness compared to a standard diet (BSD).
Main Results:
- EHD significantly decreased the odds of severe retinopathy of prematurity (ROP) (aOR=0.349, p=0.008) and late-onset sepsis (aOR=0.323, p=0.014).
- A positive trend towards decreased medical necrotizing enterocolitis (NEC) was observed, with surgical NEC rates dropping to zero.
- Direct hospital costs showed a net loss of $420 per patient, but this was deemed negligible considering long-term healthcare costs and non-pecuniary damages.
Conclusions:
- Exclusive human milk diet (EHD) is effective in reducing severe ROP and late-onset sepsis in preterm infants.
- While short-term direct costs may slightly increase, the long-term benefits and reduction in severe co-morbidities outweigh the financial implications.
- The study underscores the vital benefits of human milk for vulnerable neonates, with nominal associated costs.
Abstract:
Our level III neonatal intensive care unit (NICU) implemented the use of an exclusive human milk diet (EHD) and sought to determine its effect on the severe co-morbidities of preterm infants as well as the potential cost-savings due to the anticipated reduction in these co-morbidities. A retrospective cohort study was completed to determine if an EHD statistically decreased the rate of co-morbidities including length of stay (LOS), days on total parental nutrition (TPN), rates of late onset sepsis, necrotizing enterocolitis (NEC), bronchopulmonary dysplasia (BPD), and severe retinopathy of prematurity (ROP). An EHD significantly decreased the odds of severe ROP (adjusted odds-ratio (aOR)=0.349; 95%CI [0.156, 0.739]; p=0.008) and late onset sepsis (aOR=0.323; 95%CI [0.123, 0.768]; p=0.014). Analysis of cost-effectiveness of an EHD relative to a BSD based on the incremental costs of these co-morbidities determined the net loss in direct hospital costs per patient were estimated to be $420 in 2016 US dollars; however, given the long-term health-care costs and non-pecuniary damages from the co-morbidities of severe ROP and sepsis this net loss appears negligible. This study found that an EHD significantly decreased the odds of severe ROP and late onset sepsis; though not significant, there was a positive trend in decreasing cases of medical NEC; our surgical NEC rates dropped to 0. The benefits of human milk are vital, and the costs are nominal.
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