Impact of Optimized Breastfeeding on the Costs of Necrotizing Enterocolitis in Extremely Low Birthweight Infants - 26/07/16

Doi : 10.1016/j.jpeds.2016.03.040

Tarah T. Colaizy, MD, MPH ^1,^⁎ , Melissa C. Bartick, MD, MSc ², Briana J. Jegier, PhD ³, Brittany D. Green, MSc ⁴, Arnold G. Reinhold, MBA ⁵, Andrew J. Schaefer, PhD ⁶, Debra L. Bogen, MD ⁷, Eleanor Bimla Schwarz, MD, MS ⁸, Alison M. Stuebe, MD, MSc ^9,¹⁰
on behalf of the
Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network^{^∗}
List of additional members of the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network is available at www.jpeds.com (Appendix).
Alan H. Jobe, MD, PhD, William Oh, MD, Betty R. Vohr, MD, Rachel V. Walden, MD, Barbara Alksninis, RNC, PNP, Angelita M. Hensman, MS, RNC-NIC, BSN, Martha R. Leonard, BA, BS, Lucy Noel, Teresa M. Leach, MEd, CAES, Victoria E. Watson, MS, CAS, Avroy A. Fanaroff, MD, Michele C. Walsh, MD, MS, Deanne E. Wilson-Costello, MD, Nancy S. Newman, RN, Bonnie S. Siner, RN, Harriet G. Friedman, MA, Edward F. Donovan, MD, Kurt Schibler, MD, Jean J. Steichen, MD, Barbara Alexander, RN, Cathy Grisby, BSN, CCRC, Marcia Worley Mersmann, RN, CCRC, Holly L. Mincey, RN, BSN, Jody Hessling, RN, Teresa L. Gratton, PA, Barbara J. Stoll, MD, Ira Adams-Chapman, MD, Ellen C. Hale, RN, BS, CCRC, Maureen Mulligan LaRossa, RN, Sheena Carter, PhD, Rosemary D. Higgins, MD, Linda L. Wright, MD, Elizabeth M. McClure, MEd, Brenda B. Poindexter, MD, MS, James A. Lemons, MD, Anna M. Dusick, MD, Darlene Kardatzke, MD, Carolyn Lytle, MD, MPH, Diana D. Appel, RN, BSN, Lon G. Bohnke, MS, Greg Eaken, PhD, Dianne E. Herron, RN, Lucy C. Miller, RN, BSN, CCRC, Leslie Richard, RN, Leslie Dawn Wilson, BSN, CCRC, Abhik Das, PhD, W. Kenneth Poole, PhD, Lisa Ann Wrage, MPH, Betty K. Hastings, Elizabeth M. McClure, MEd, Jeanette O'Donnell Auman, BS, Sarah Taylor, BSPH, David K. Stevenson, MD, Susan R. Hintz, MD, MS, Epi, M. Bethany Ball, BS, CCRC, Jean G. Kohn, MD, MPH, Joan M. Baran, PhD, Julie C. Lee-Ancajas, PhD, Nicholas H. St. John, PhD, Waldemar A. Carlo, MD, Namasivayam Ambalavanan, MD, Kathleen G. Nelson, MD, Myriam Peralta-Carcelen, MD, MPH, Kirstin J. Bailey, PhD, Fred J. Biasini, PhD, Stephanie A. Chopko, PhD, Monica V. Collins, RN, BSN, MaEd, Shirley S. Cosby, RN, BSN, Vivien A. Phillips, RN, BSN, Richard V. Rector, PhD, Neil N. Finer, MD, Yvonne E. Vaucher, MD, MPH, Jack M. Anderson, MD, Maynard R. Rasmussen, MD, Kathy Arnell, RNC, Clarence Demetrio, RN, Martha G. Fuller, RN, MSN, Christopher Henderson, AS, CRTT, Donna Posin, OTR/L, MPA, Edward F. Bell, MD, Tarah T. Colaizy, MD, MPH, Charles R. Bauer, MD, Shahnaz Duara, MD, Amy Mur Worth, RN, MS, Ruth Everett-Thomas, RN, MSN, Alexis N. Diaz, BA, Elaine O. Mathews, RN, Kasey Hamlin-Smith, PhD, Lisa Jean-Gilles, BA, Maria Calejo, MS, Silvia M. Frade, BA, Silvia Hiriart-Fajardo, MD, Yamiley Gideon, BA, Sheldon B. Korones, MD, Henrietta S. Bada, MD, Tina Hudson, RN, BSN, Kimberly Yolton, PhD, Marilyn G. Williams, EdD, MSW, LCSW, Abbot R. Laptook, MD, Walid A. Salhab, MD, R. Sue Broyles, MD, Susie Madison, RN, Jackie F. Hickman, RN, Alicia Guzman, Sally S. Adams, MS, RN, CPNP, Linda A. Madden, BSN, RN, CPNP, Elizabeth T. Heyne, PsyD, PA-C, Cristin Dooley, PhD, LSSP, Seetha Shankaran, MD, Virginia Delaney-Black, MD, MPH, Yvette R. Johnson, MD, MPH, Rebecca Bara, RN, BSN, Geraldine Muran, RN, BSN, Deborah Kennedy, RN, BSN, Laura A. Goldston, MA, Richard A. Ehrenkranz, MD, Patricia Gettner, RN, Monica Konstantino, RN, BSN, Elaine Romano, MSN, Nancy Close, PhD, Walter S. Gilliam, PhD, JoAnn Poulsen, RN

¹ Carver College of Medicine, University of Iowa, Iowa City, IA
² Department of Medicine, Cambridge Health Alliance and Harvard Medical School, Cambridge, MA
³ D'Youville College, Buffalo, NY
⁴ Department of Industrial Engineering, University of Pittsburgh, Pittsburgh, PA
⁵ Alliance for the Prudent Use of Antibiotics, Boston, MA
⁶ Department of Computational and Applied Mathematics, Rice University, Houston, TX
⁷ Department of Pediatrics, University of Pittsburgh, Pittsburgh, PA
⁸ Department of Medicine, University of California, Davis, Davis, CA
⁹ Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, NC
¹⁰ Carolina Global Breastfeeding Institute, Gillings School of Global Public Health, Chapel Hill, NC

^∗Reprint requests: Tarah T. Colaizy, MD, MPH, Carver College of Medicine, University of Iowa, 200 Hawkins Dr, 8809 JPP, Iowa City, IA, 52242.Carver College of MedicineUniversity of Iowa200 Hawkins Dr, 8809 JPPIowa CityIA52242

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.

Le texte complet de cet article est disponible en PDF.

Keywords : necrotizing enterocolitis, human milk, monte carlo modeling, economic analysis

Abbreviations : ELBW, NEC, NICU, PF, PMA, VLBW, VON

Plan

Methods

Results

Discussion

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.

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Impact of Optimized Breastfeeding on the Costs of Necrotizing Enterocolitis in Extremely Low Birthweight Infants - 26/07/16

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