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Economic and Clinical Impact of Using Human Milk-Derived Fortifier in Very Low Birth Weight Infants
Manas Tetarbe1, Millie Rocio Chang2, Lorayne Barton1
1Division of Neonatology, Department of Pediatrics, Los Angeles General Medical Center, Keck School of Medicine of USC, Los Angeles, California, USA.
Insights
Exclusive human milk (EHM) feeding for very low birth weight (VLBW) infants is cost-effective. This feeding strategy reduces hospital length of stay and parenteral nutrition days without increasing short-term morbidities.
Area of Science:
- Neonatalogy
- Clinical Nutrition
- Health Economics
Background:
- Exclusive human milk (EHM) feeding, using mother's own or donor milk with human milk-derived fortifiers, can be costly for healthcare institutions.
- Very low birth weight (VLBW) infants often require specialized nutritional support, impacting institutional costs.
Purpose of the Study:
- To evaluate the economic impact and clinical outcomes of implementing exclusive human milk (EHM) feeding guidelines for VLBW infants.
- To determine if EHM feeding is a cost-effective strategy for neonatal intensive care units (NICUs).
Main Methods:
- A retrospective study comparing VLBW infants before and after EHM implementation.
- Data collected included neonatal demographics, clinical outcomes (necrotizing enterocolitis, retinopathy of prematurity, bronchopulmonary dysplasia, late-onset sepsis), days on parenteral nutrition (PN), and length of stay.
- Institutional costs were estimated using published data and cost avoidance from clinical outcomes.
Main Results:
- The study included 64 infants pre-EHM and 57 infants post-EHM.
- EHM implementation resulted in a mean reduction of 6.3 days in length of stay and 6.8 days in PN use per infant.
- A cost saving of $1,813,444 was observed, with an estimated 2-year financial impact of $913,840, excluding insurance reimbursement.
- No significant differences in short-term morbidities were found between the groups.
Conclusions:
- Implementing EHM feeding for VLBW infants is a cost-effective approach for NICUs.
- EHM feeding can lead to reduced length of stay and decreased reliance on PN without compromising short-term clinical outcomes.
Abstract:
Implementation of exclusive human milk (EHM) feeding defined as mother's own milk or donor human milk fortified with human milk-derived fortifiers can place an economic burden on institutions. Retrospective study of very low birth weight (VLBW) infants before and after the implementation of EHM feedings. Neonatal demographics and clinical outcomes including necrotizing enterocolitis, severe retinopathy of prematurity, bronchopulmonary dysplasia, late-onset sepsis, days on parenteral nutrition (PN), and length-of-stay were collected. The net cost to the institution was estimated using published data. Sixty-four infants in the pre-EHM period and 57 infants in the post-EHM period were enrolled. Net product acquisition cost in 2020 and 2021 was $884,823. The EHM feeding guideline led to a reduction in the mean length of stay and mean days of PN use by 6.3 and 6.8 days per infant, respectively. This led to a cost saving of $1,813,444 ($31,815 per infant). No significant difference in incidence of short-term morbidities was observed. Combining the cost avoidance from clinical outcomes, the estimated financial impact over 2 years excluding insurance reimbursement was an estimated $ 913,840 ($16,032 per infant). Implementation of EHM-based feeding in VLBW infants is a cost-effective option for neonatal intensive care units that can result in reduced length of stay and days on PN without adversely impacting short-term morbidities.
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