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

Tarah T Colaizy; Melissa C Bartick; Briana J Jegier; Brittany D Green; Arnold G Reinhold; Andrew J Schaefer; Debra L Bogen; Eleanor Bimla Schwarz; Alison M Stuebe; Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network

doi:10.1016/j.jpeds.2016.03.040

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

Journal article

Peer reviewed

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

Tarah T Colaizy, Melissa C Bartick, Briana J Jegier, Brittany D Green, Arnold G Reinhold, Andrew J Schaefer, Debra L Bogen, Eleanor Bimla Schwarz, Alison M Stuebe and Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network

The Journal of pediatrics, Vol.175, pp.100-105.e2

08/2016

DOI: 10.1016/j.jpeds.2016.03.040

PMCID: PMC5274635

PMID: 27131403

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http://doi.org/10.1016/j.jpeds.2016.03.040View

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Abstract

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. 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. 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. 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.

Infant, Extremely Low Birth Weight

Infant, Premature, Diseases - economics

United States - epidemiology

Infant, Premature, Diseases - prevention & control

Breast Feeding - economics

Enterocolitis, Necrotizing - prevention & control

Humans

Infant Formula - economics

Models, Economic

Enterocolitis, Necrotizing - epidemiology

Enterocolitis, Necrotizing - economics

Health Care Costs - statistics & numerical data

Infant, Premature

Infant, Premature, Diseases - epidemiology

Monte Carlo Method

Infant, Newborn

Milk, Human

Details

Title: Subtitle: Impact of Optimized Breastfeeding on the Costs of Necrotizing Enterocolitis in Extremely Low Birthweight Infants
Creators: Tarah T Colaizy - Carver College of Medicine, University of Iowa, Iowa City, IA. Electronic address: tarah-colaizy@uiowa.edu
Melissa C Bartick - Department of Medicine, Cambridge Health Alliance and Harvard Medical School, Cambridge, MA
Briana J Jegier - D'Youville College, Buffalo, NY
Brittany D Green - Department of Industrial Engineering, University of Pittsburgh, Pittsburgh, PA
Arnold G Reinhold - Alliance for the Prudent Use of Antibiotics, Boston, MA
Andrew J Schaefer - Department of Computational and Applied Mathematics, Rice University, Houston, TX
Debra L Bogen - Department of Pediatrics, University of Pittsburgh, Pittsburgh, PA
Eleanor Bimla Schwarz - Department of Medicine, University of California, Davis, Davis, CA
Alison M Stuebe - 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
Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network
Resource Type: Journal article
Publication Details: The Journal of pediatrics, Vol.175, pp.100-105.e2
DOI: 10.1016/j.jpeds.2016.03.040
PMID: 27131403
PMCID: PMC5274635
NLM abbreviation: J Pediatr
ISSN: 0022-3476
eISSN: 1097-6833
Grant note: U10 HD053109 / NICHD NIH HHS U10 HD027856 / NICHD NIH HHS UG1 HD027904 / NICHD NIH HHS U10 HD027880 / NICHD NIH HHS U10 HD027853 / NICHD NIH HHS U10 HD021364 / NICHD NIH HHS U10 HD027851 / NICHD NIH HHS U10 HD027871 / NICHD NIH HHS M01 RR008084 / NCRR NIH HHS M01 RR006022 / NCRR NIH HHS U10 HD034216 / NICHD NIH HHS M01 RR016587 / NCRR NIH HHS UG1 HD027880 / NICHD NIH HHS UG1 HD053109 / NICHD NIH HHS U10 HD021397 / NICHD NIH HHS U10 HD036790 / NICHD NIH HHS U10 HD021385 / NICHD NIH HHS T32 GM007752 / NIGMS NIH HHS U10 HD040461 / NICHD NIH HHS UG1 HD027856 / NICHD NIH HHS U10 HD040689 / NICHD NIH HHS UG1 HD027853 / NICHD NIH HHS U10 HD027904 / NICHD NIH HHS
Language: English
Date published: 08/2016
Academic Unit: Stead Family Department of Pediatrics; Neonatology
Record Identifier: 9984093221702771

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