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

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• 作者：Tarah T. Colaizy ; MD ; MPH¹ ; ^{tarah-colaizy@uiowa.edu" class="auth_mail" title="E-mail the corresponding author} ; Melissa C. Bartick ; MD ; MSc² ; Briana J. Jegier ; PhD³ ; Brittany D. Green ; MSc⁴ ; Arnold G. Reinhold ; MBA⁵ ; Andrew J. Schaefer ; PhD⁶ ; Debra L. Bogen ; MD⁷ ; Eleanor Bimla Schwarz ; MD ; MS⁸ ; Alison M. Stuebe ; MD ; MSc⁹ ; ¹⁰ ; on behalf of the Eunice Kennedy Shriver National Institute of Child Health ; Human Development Neonatal Research Network^&lowast ; ; 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
• 关键词：necrotizing enterocolitis ; human milk ; monte carlo modeling ; economic analysis
• 刊名：The Journal of Pediatrics
• 出版年：2016
• 出版时间：August 2016
• 年：2016
• 卷：175
• 期：Complete
• 页码：100-105.e2
• 全文大小：316 K

文摘

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.