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; Alan H. Jobe; William Oh; Betty R. Vohr; Rachel V. Walden; Barbara Alksninis; Angelita M. Hensman; Martha R. Leonard; Lucy Noel; Teresa M. Leach; Victoria E. Watson; Avroy A. Fanaroff; Michele C. Walsh; Deanne E. Wilson-Costello; Nancy S. Newman; Bonnie S. Siner; Harriet G. Friedman; Edward F. Donovan; Kurt Schibler; Jean J. Steichen; Barbara Alexander; Cathy Grisby; Marcia Worley Mersmann; Holly L. Mincey; Jody Hessling; Teresa L. Gratton; Barbara J. Stoll; Ira Adams-Chapman; Ellen C. Hale; Maureen Mulligan LaRossa; Sheena Carter; Rosemary D. Higgins; Linda L. Wright; Elizabeth M. McClure; Brenda B. Poindexter; James A. Lemons; Anna M. Dusick; Darlene Kardatzke; Carolyn Lytle; Diana D. Appel; Lon G. Bohnke; Greg Eaken; Dianne E. Herron; Lucy C. Miller; Leslie Richard; Leslie Dawn Wilson; Abhik Das; W. Kenneth Poole; Lisa Ann Wrage; Betty K. Hastings; Elizabeth M. McClure; Jeanette O'Donnell Auman; Sarah Taylor; David K. Stevenson; Susan R. Hintz; M. Bethany Ball; Jean G. Kohn; Joan M. Baran; Julie C. Lee-Ancajas; Nicholas H. St. John; Waldemar A. Carlo; Namasivayam Ambalavanan; Kathleen G. Nelson; Myriam Peralta-Carcelen; Kirstin J. Bailey; Fred J. Biasini; Stephanie A. Chopko; Monica V. Collins; Shirley S. Cosby; Vivien A. Phillips; Richard V. Rector; Neil N. Finer; Yvonne E. Vaucher; Jack M. Anderson; Maynard R. Rasmussen; Kathy Arnell; Clarence Demetrio; Martha G. Fuller; Christopher Henderson; Donna Posin; Edward F. Bell; Charles R. Bauer; Shahnaz Duara; Amy Mur Worth; Ruth Everett-Thomas; Alexis N. Diaz; Elaine O. Mathews; Kasey Hamlin-Smith; Lisa Jean-Gilles; Maria Calejo; Silvia M. Frade; Silvia Hiriart-Fajardo; Yamiley Gideon; Sheldon B. Korones; Henrietta S. Bada; Tina Hudson; Kimberly Yolton; Marilyn G. Williams; Abbot R. Laptook; Walid A. Salhab; R. Sue Broyles; Susie Madison; Jackie F. Hickman; Alicia Guzman; Sally S. Adams; Linda A. Madden; Elizabeth T. Heyne; Cristin Dooley; Seetha Shankaran; Virginia Delaney-Black; Yvette R. Johnson; Rebecca Bara; Geraldine Muran; Deborah Kennedy; Laura A. Goldston; Richard A. Ehrenkranz; Patricia Gettner; Monica Konstantino; Elaine Romano; Nancy Close; Walter S. Gilliam; Jo Ann Poulsen

doi:10.1016/j.jpeds.2016.03.040

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, Alan H. Jobe, William Oh, Betty R. Vohr, Rachel V. Walden, Barbara Alksninis, Angelita M. Hensman, Martha R. Leonard, Lucy Noel, Teresa M. Leach, Victoria E. Watson, Avroy A. FanaroffMichele C. Walsh, Deanne E. Wilson-Costello, Nancy S. Newman, Bonnie S. Siner, Harriet G. Friedman, Edward F. Donovan, Kurt Schibler, Jean J. Steichen, Barbara Alexander, Cathy Grisby, Marcia Worley Mersmann, Holly L. Mincey, Jody Hessling, Teresa L. Gratton, Barbara J. Stoll, Ira Adams-Chapman, Ellen C. Hale, Maureen Mulligan LaRossa, Sheena Carter, Rosemary D. Higgins, Linda L. Wright, Elizabeth M. McClure, Brenda B. Poindexter, James A. Lemons, Anna M. Dusick, Darlene Kardatzke, Carolyn Lytle, Diana D. Appel, Lon G. Bohnke, Greg Eaken, Dianne E. Herron, Lucy C. Miller, Leslie Richard, Leslie Dawn Wilson, Abhik Das, W. Kenneth Poole, Lisa Ann Wrage, Betty K. Hastings, Elizabeth M. McClure, Jeanette O'Donnell Auman, Sarah Taylor, David K. Stevenson, Susan R. Hintz, M. Bethany Ball, Jean G. Kohn, Joan M. Baran, Julie C. Lee-Ancajas, Nicholas H. St. John, Waldemar A. Carlo, Namasivayam Ambalavanan, Kathleen G. Nelson, Myriam Peralta-Carcelen, Kirstin J. Bailey, Fred J. Biasini, Stephanie A. Chopko, Monica V. Collins, Shirley S. Cosby, Vivien A. Phillips, Richard V. Rector, Neil N. Finer, Yvonne E. Vaucher, Jack M. Anderson, Maynard R. Rasmussen, Kathy Arnell, Clarence Demetrio, Martha G. Fuller, Christopher Henderson, Donna Posin, Edward F. Bell, Charles R. Bauer, Shahnaz Duara, Amy Mur Worth, Ruth Everett-Thomas, Alexis N. Diaz, Elaine O. Mathews, Kasey Hamlin-Smith, Lisa Jean-Gilles, Maria Calejo, Silvia M. Frade, Silvia Hiriart-Fajardo, Yamiley Gideon, Sheldon B. Korones, Henrietta S. Bada, Tina Hudson, Kimberly Yolton, Marilyn G. Williams, Abbot R. Laptook, Walid A. Salhab, R. Sue Broyles, Susie Madison, Jackie F. Hickman, Alicia Guzman, Sally S. Adams, Linda A. Madden, Elizabeth T. Heyne, Cristin Dooley, Seetha Shankaran, Virginia Delaney-Black, Yvette R. Johnson, Rebecca Bara, Geraldine Muran, Deborah Kennedy, Laura A. Goldston, Richard A. Ehrenkranz, Patricia Gettner, Monica Konstantino, Elaine Romano, Nancy Close, Walter S. Gilliam, Jo Ann Poulsen

Research output: Contribution to journal › Article › peer-review

51 Scopus citations

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.

Original language	English
Pages (from-to)	100-105.e2
Journal	Journal of Pediatrics
Volume	175
DOIs	https://doi.org/10.1016/j.jpeds.2016.03.040
State	Published - Aug 1 2016

Bibliographical note

Funding Information:
Funded by W.K. Kellogg Foundation (P3024102) and the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD; U10 HD053109). NICHD and the National Center for Research Resources supported the Neonatal Research Network's Glutamine Trial through cooperative agreements [Appendix]). Participating sites collected data and transmitted it to RTI International, the data coordinating center for the network, which stored, managed, and analyzed the data for this study. Although NICHD staff did have input into the study design, conduct, analysis, and manuscript drafting, the content is solely the responsibility of the authors and does not necessarily represent the official views of NICHD. The authors declare no conflicts of interest.

Publisher Copyright:
© 2016 Elsevier Inc.

Keywords

economic analysis
human milk
monte carlo modeling
necrotizing enterocolitis

ASJC Scopus subject areas

Pediatrics, Perinatology, and Child Health

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1016/j.jpeds.2016.03.040

Cite this

Colaizy, T. T., Bartick, M. C., Jegier, B. J., Green, B. D., Reinhold, A. G., Schaefer, A. J., Bogen, D. L., Schwarz, E. B., Stuebe, A. M., Jobe, A. H., Oh, W., Vohr, B. R., Walden, R. V., Alksninis, B., Hensman, A. M., Leonard, M. R., Noel, L., Leach, T. M., Watson, V. E., ... Poulsen, J. A. (2016). Impact of Optimized Breastfeeding on the Costs of Necrotizing Enterocolitis in Extremely Low Birthweight Infants. Journal of Pediatrics, 175, 100-105.e2. https://doi.org/10.1016/j.jpeds.2016.03.040

@article{41c67ae2732f4b3d82e76e0998c50708,

title = "Impact of Optimized Breastfeeding on the Costs of Necrotizing Enterocolitis in Extremely Low Birthweight Infants",

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",

author = "Colaizy, {Tarah T.} and Bartick, {Melissa C.} and Jegier, {Briana J.} and Green, {Brittany D.} and Reinhold, {Arnold G.} and Schaefer, {Andrew J.} and Bogen, {Debra L.} and Schwarz, {Eleanor Bimla} and Stuebe, {Alison M.} and Jobe, {Alan H.} and William Oh and Vohr, {Betty R.} and Walden, {Rachel V.} and Barbara Alksninis and Hensman, {Angelita M.} and Leonard, {Martha R.} and Lucy Noel and Leach, {Teresa M.} and Watson, {Victoria E.} and Fanaroff, {Avroy A.} and Walsh, {Michele C.} and Wilson-Costello, {Deanne E.} and Newman, {Nancy S.} and Siner, {Bonnie S.} and Friedman, {Harriet G.} and Donovan, {Edward F.} and Kurt Schibler and Steichen, {Jean J.} and Barbara Alexander and Cathy Grisby and Mersmann, {Marcia Worley} and Mincey, {Holly L.} and Jody Hessling and Gratton, {Teresa L.} and Stoll, {Barbara J.} and Ira Adams-Chapman and Hale, {Ellen C.} and LaRossa, {Maureen Mulligan} and Sheena Carter and Higgins, {Rosemary D.} and Wright, {Linda L.} and McClure, {Elizabeth M.} and Poindexter, {Brenda B.} and Lemons, {James A.} and Dusick, {Anna M.} and Darlene Kardatzke and Carolyn Lytle and Appel, {Diana D.} and Bohnke, {Lon G.} and Greg Eaken and Herron, {Dianne E.} and Miller, {Lucy C.} and Leslie Richard and Wilson, {Leslie Dawn} and Abhik Das and Poole, {W. Kenneth} and Wrage, {Lisa Ann} and Hastings, {Betty K.} and McClure, {Elizabeth M.} and {O'Donnell Auman}, Jeanette and Sarah Taylor and Stevenson, {David K.} and Hintz, {Susan R.} and Ball, {M. Bethany} and Kohn, {Jean G.} and Baran, {Joan M.} and Lee-Ancajas, {Julie C.} and {St. John}, {Nicholas H.} and Carlo, {Waldemar A.} and Namasivayam Ambalavanan and Nelson, {Kathleen G.} and Myriam Peralta-Carcelen and Bailey, {Kirstin J.} and Biasini, {Fred J.} and Chopko, {Stephanie A.} and Collins, {Monica V.} and Cosby, {Shirley S.} and Phillips, {Vivien A.} and Rector, {Richard V.} and Finer, {Neil N.} and Vaucher, {Yvonne E.} and Anderson, {Jack M.} and Rasmussen, {Maynard R.} and Kathy Arnell and Clarence Demetrio and Fuller, {Martha G.} and Christopher Henderson and Donna Posin and Bell, {Edward F.} and Bauer, {Charles R.} and Shahnaz Duara and Worth, {Amy Mur} and Ruth Everett-Thomas and Diaz, {Alexis N.} and Mathews, {Elaine O.} and Kasey Hamlin-Smith and Lisa Jean-Gilles and Maria Calejo and Frade, {Silvia M.} and Silvia Hiriart-Fajardo and Yamiley Gideon and Korones, {Sheldon B.} and Bada, {Henrietta S.} and Tina Hudson and Kimberly Yolton and Williams, {Marilyn G.} and Laptook, {Abbot R.} and Salhab, {Walid A.} and Broyles, {R. Sue} and Susie Madison and Hickman, {Jackie F.} and Alicia Guzman and Adams, {Sally S.} and Madden, {Linda A.} and Heyne, {Elizabeth T.} and Cristin Dooley and Seetha Shankaran and Virginia Delaney-Black and Johnson, {Yvette R.} and Rebecca Bara and Geraldine Muran and Deborah Kennedy and Goldston, {Laura A.} and Ehrenkranz, {Richard A.} and Patricia Gettner and Monica Konstantino and Elaine Romano and Nancy Close and Gilliam, {Walter S.} and Poulsen, {Jo Ann}",

note = "Funding Information: Funded by W.K. Kellogg Foundation (P3024102) and the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD; U10 HD053109). NICHD and the National Center for Research Resources supported the Neonatal Research Network's Glutamine Trial through cooperative agreements [Appendix]). Participating sites collected data and transmitted it to RTI International, the data coordinating center for the network, which stored, managed, and analyzed the data for this study. Although NICHD staff did have input into the study design, conduct, analysis, and manuscript drafting, the content is solely the responsibility of the authors and does not necessarily represent the official views of NICHD. The authors declare no conflicts of interest. Publisher Copyright: {\textcopyright} 2016 Elsevier Inc.",

year = "2016",

month = aug,

day = "1",

doi = "10.1016/j.jpeds.2016.03.040",

language = "English",

volume = "175",

pages = "100--105.e2",

}

Colaizy, TT, Bartick, MC, Jegier, BJ, Green, BD, Reinhold, AG, Schaefer, AJ, Bogen, DL, Schwarz, EB, Stuebe, AM, Jobe, AH, Oh, W, Vohr, BR, Walden, RV, Alksninis, B, Hensman, AM, Leonard, MR, Noel, L, Leach, TM, Watson, VE, Fanaroff, AA, Walsh, MC, Wilson-Costello, DE, Newman, NS, Siner, BS, Friedman, HG, Donovan, EF, Schibler, K, Steichen, JJ, Alexander, B, Grisby, C, Mersmann, MW, Mincey, HL, Hessling, J, Gratton, TL, Stoll, BJ, Adams-Chapman, I, Hale, EC, LaRossa, MM, Carter, S, Higgins, RD, Wright, LL, McClure, EM, Poindexter, BB, Lemons, JA, Dusick, AM, Kardatzke, D, Lytle, C, Appel, DD, Bohnke, LG, Eaken, G, Herron, DE, Miller, LC, Richard, L, Wilson, LD, Das, A, Poole, WK, Wrage, LA, Hastings, BK, McClure, EM, O'Donnell Auman, J, Taylor, S, Stevenson, DK, Hintz, SR, Ball, MB, Kohn, JG, Baran, JM, Lee-Ancajas, JC, St. John, NH, Carlo, WA, Ambalavanan, N, Nelson, KG, Peralta-Carcelen, M, Bailey, KJ, Biasini, FJ, Chopko, SA, Collins, MV, Cosby, SS, Phillips, VA, Rector, RV, Finer, NN, Vaucher, YE, Anderson, JM, Rasmussen, MR, Arnell, K, Demetrio, C, Fuller, MG, Henderson, C, Posin, D, Bell, EF, Bauer, CR, Duara, S, Worth, AM, Everett-Thomas, R, Diaz, AN, Mathews, EO, Hamlin-Smith, K, Jean-Gilles, L, Calejo, M, Frade, SM, Hiriart-Fajardo, S, Gideon, Y, Korones, SB, Bada, HS, Hudson, T, Yolton, K, Williams, MG, Laptook, AR, Salhab, WA, Broyles, RS, Madison, S, Hickman, JF, Guzman, A, Adams, SS, Madden, LA, Heyne, ET, Dooley, C, Shankaran, S, Delaney-Black, V, Johnson, YR, Bara, R, Muran, G, Kennedy, D, Goldston, LA, Ehrenkranz, RA, Gettner, P, Konstantino, M, Romano, E, Close, N, Gilliam, WS & Poulsen, JA 2016, 'Impact of Optimized Breastfeeding on the Costs of Necrotizing Enterocolitis in Extremely Low Birthweight Infants', Journal of Pediatrics, vol. 175, pp. 100-105.e2. https://doi.org/10.1016/j.jpeds.2016.03.040

TY - JOUR

T1 - Impact of Optimized Breastfeeding on the Costs of Necrotizing Enterocolitis in Extremely Low Birthweight Infants

AU - Colaizy, Tarah T.

AU - Bartick, Melissa C.

AU - Jegier, Briana J.

AU - Green, Brittany D.

AU - Reinhold, Arnold G.

AU - Schaefer, Andrew J.

AU - Bogen, Debra L.

AU - Schwarz, Eleanor Bimla

AU - Stuebe, Alison M.

AU - Jobe, Alan H.

AU - Oh, William

AU - Vohr, Betty R.

AU - Walden, Rachel V.

AU - Alksninis, Barbara

AU - Hensman, Angelita M.

AU - Leonard, Martha R.

AU - Noel, Lucy

AU - Leach, Teresa M.

AU - Watson, Victoria E.

AU - Fanaroff, Avroy A.

AU - Walsh, Michele C.

AU - Wilson-Costello, Deanne E.

AU - Newman, Nancy S.

AU - Siner, Bonnie S.

AU - Friedman, Harriet G.

AU - Donovan, Edward F.

AU - Schibler, Kurt

AU - Steichen, Jean J.

AU - Alexander, Barbara

AU - Grisby, Cathy

AU - Mersmann, Marcia Worley

AU - Mincey, Holly L.

AU - Hessling, Jody

AU - Gratton, Teresa L.

AU - Stoll, Barbara J.

AU - Adams-Chapman, Ira

AU - Hale, Ellen C.

AU - LaRossa, Maureen Mulligan

AU - Carter, Sheena

AU - Higgins, Rosemary D.

AU - Wright, Linda L.

AU - McClure, Elizabeth M.

AU - Poindexter, Brenda B.

AU - Lemons, James A.

AU - Dusick, Anna M.

AU - Kardatzke, Darlene

AU - Lytle, Carolyn

AU - Appel, Diana D.

AU - Bohnke, Lon G.

AU - Eaken, Greg

AU - Herron, Dianne E.

AU - Miller, Lucy C.

AU - Richard, Leslie

AU - Wilson, Leslie Dawn

AU - Das, Abhik

AU - Poole, W. Kenneth

AU - Wrage, Lisa Ann

AU - Hastings, Betty K.

AU - McClure, Elizabeth M.

AU - O'Donnell Auman, Jeanette

AU - Taylor, Sarah

AU - Stevenson, David K.

AU - Hintz, Susan R.

AU - Ball, M. Bethany

AU - Kohn, Jean G.

AU - Baran, Joan M.

AU - Lee-Ancajas, Julie C.

AU - St. John, Nicholas H.

AU - Carlo, Waldemar A.

AU - Ambalavanan, Namasivayam

AU - Nelson, Kathleen G.

AU - Peralta-Carcelen, Myriam

AU - Bailey, Kirstin J.

AU - Biasini, Fred J.

AU - Chopko, Stephanie A.

AU - Collins, Monica V.

AU - Cosby, Shirley S.

AU - Phillips, Vivien A.

AU - Rector, Richard V.

AU - Finer, Neil N.

AU - Vaucher, Yvonne E.

AU - Anderson, Jack M.

AU - Rasmussen, Maynard R.

AU - Arnell, Kathy

AU - Demetrio, Clarence

AU - Fuller, Martha G.

AU - Henderson, Christopher

AU - Posin, Donna

AU - Bell, Edward F.

AU - Bauer, Charles R.

AU - Duara, Shahnaz

AU - Worth, Amy Mur

AU - Everett-Thomas, Ruth

AU - Diaz, Alexis N.

AU - Mathews, Elaine O.

AU - Hamlin-Smith, Kasey

AU - Jean-Gilles, Lisa

AU - Calejo, Maria

AU - Frade, Silvia M.

AU - Hiriart-Fajardo, Silvia

AU - Gideon, Yamiley

AU - Korones, Sheldon B.

AU - Bada, Henrietta S.

AU - Hudson, Tina

AU - Yolton, Kimberly

AU - Williams, Marilyn G.

AU - Laptook, Abbot R.

AU - Salhab, Walid A.

AU - Broyles, R. Sue

AU - Madison, Susie

AU - Hickman, Jackie F.

AU - Guzman, Alicia

AU - Adams, Sally S.

AU - Madden, Linda A.

AU - Heyne, Elizabeth T.

AU - Dooley, Cristin

AU - Shankaran, Seetha

AU - Delaney-Black, Virginia

AU - Johnson, Yvette R.

AU - Bara, Rebecca

AU - Muran, Geraldine

AU - Kennedy, Deborah

AU - Goldston, Laura A.

AU - Ehrenkranz, Richard A.

AU - Gettner, Patricia

AU - Konstantino, Monica

AU - Romano, Elaine

AU - Close, Nancy

AU - Gilliam, Walter S.

AU - Poulsen, Jo Ann

N1 - Funding Information: Funded by W.K. Kellogg Foundation (P3024102) and the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD; U10 HD053109). NICHD and the National Center for Research Resources supported the Neonatal Research Network's Glutamine Trial through cooperative agreements [Appendix]). Participating sites collected data and transmitted it to RTI International, the data coordinating center for the network, which stored, managed, and analyzed the data for this study. Although NICHD staff did have input into the study design, conduct, analysis, and manuscript drafting, the content is solely the responsibility of the authors and does not necessarily represent the official views of NICHD. The authors declare no conflicts of interest. Publisher Copyright: © 2016 Elsevier Inc.

PY - 2016/8/1

Y1 - 2016/8/1

N2 - 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.

AB - 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.

KW - economic analysis

KW - human milk

KW - monte carlo modeling

KW - necrotizing enterocolitis

UR - http://www.scopus.com/inward/record.url?scp=84964669478&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84964669478&partnerID=8YFLogxK

U2 - 10.1016/j.jpeds.2016.03.040

DO - 10.1016/j.jpeds.2016.03.040

M3 - Article

C2 - 27131403

AN - SCOPUS:84964669478

SN - 0022-3476

VL - 175

SP - 100-105.e2

JO - Journal of Pediatrics

JF - Journal of Pediatrics

ER -

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

Abstract

Bibliographical note

Keywords

ASJC Scopus subject areas

UN SDGs

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