Economic Outcomes

More on Econmic Outcomes

Impact of Early Human Milk on Sepsis and Health-Care Costs in Very Low Birth Weight Infants

Citation: AL Patel, TJ Johnson, JL Engstrom, LF Fogg, BJ Jegier, HER Bigger and PP Meier

Objective: To study the incidence of sepsis and neonatal intensive care unit (NICU) costs as a function of the human milk (HM) dose received during the first 28 days post birth for very low birth weight (VLBW) infants.

Design: Prospective cohort study of 175 VLBW infants. The average daily dose of HM (ADDHM) was calculated from daily nutritional data for the first 28 days post birth (ADDHM-Days 1–28). Other covariates associated with sepsis were used to create a propensity score, combining multiple risk factors into a single metric.

Results: The mean gestational age and birth weight were 28.1±2.4 weeks and 1087±252 g, respectively. The mean ADDHM-Days 1–28 was 54±39 ml kg1 day1 (range 0–135). Binary logistic regression analysis controlling for propensity score revealed that increasing ADDHM-Days 1–28 was associated with lower odds of sepsis (odds ratio 0.981, 95% confidence interval 0.967–0.995, P¼0.008). Increasing ADDHM-Days 1–28 was associated with significantly lower NICU costs.

Conclusion: A dose–response relationship was demonstrated between ADDHM-Days 1–28 and a reduction in the odds of sepsis and associated NICU costs after controlling for propensity score. For every HM dose increase of 10 ml kg1 day1, the odds of sepsis decreased by 19%. NICU costs were lowest in the VLBW infants who received the highest ADDHM-Days 1–28.

Journal of Perinatology advance online publication, 31 January 2013; doi:10.1038/jp.2013.2

Keywords: premature infant; breast milk; infection; economics; health-care costs


return to top

Cost of Morbidities in Very Low Birth Weight Infants

Citation: Tricia J. Johnson, PhD, Aloka L. Patel, MD, Briana J. Jegier, PhD, CLC, Janet L. Engstrom, PhD, RN, CNM, WHNP-BC, and Paula P. Meier, PhD, RN, FAAN

Objective: To determine the association between direct costs for the initial neonatal intensive care unit hospitalization and 4 potentially preventable morbidities in a retrospective cohort of very low birth weight (VLBW) infants (birth weight <1500 g).

Study design: The sample included 425 VLBW infants born alive between July 2005 and June 2009 at Rush University Medical Center. Morbidities included brain injury, necrotizing enterocolitis, bronchopulmonary dysplasia, and late-onset sepsis. Clinical and economic data were retrieved from the institution’s system-wide data and cost accounting system. A general linear regression model was fit to determine incremental direct costs associated with each morbidity.

Results: After controlling for birth weight, gestational age, and sociodemographic characteristics, the presence of brain injury was associated with a $12 048 (P = .005) increase in direct costs; necrotizing enterocolitis, with a $15 440 (P = .005) increase; bronchopulmonary dysplasia, with a $31 565 (P < .001) increase; and late-onset sepsis, with a $10 055 (P < .001) increase. The absolute number of morbidities was also associated with significantly higher costs.

Conclusion: This study provides collective estimates of the direct costs incurred during neonatal intensive care unit hospitalization for these 4 morbidities in VLBW infants. The incremental costs associated with these morbidities are high, and these data can inform future studies.

Original Article: Cost of Morbidities in Very Low Birth Weight Infants -RushCostOfMorbidities_JPeds.pdf  return to top

Health, nutrition and cost outcomes of human milk feedings for very low birthweight infants.
Citation: Meier, P. P., & Bode, L.  (2013). Health, nutrition and cost outcomes of human milk feedings for very low birthweight infants.  Advances in Nutrition, 4, 670-671.

return to top

The initial maternal cost of providing 100 mLs of human milk for very low birthweight infants in the neonatal intensive care unit

Citation: Jegier, B. J., Meier, P. P., Engstrom, J. L., & McBride, T. (2010). The initial maternal cost of providing 100 mLs of human milk for very low birthweight infants in the neonatal intensive care unit. Breastfeeding Medicine, 5, 1-7.

return to top

Economic Benefits and Costs of Human Milk Feedings: A Strategy to Reduce the Risk of Prematurity-Related Morbidities in Very-Low- Birth-Weight Infants

Citation: TJ Johnson, AL Patel, HER Bigger, JL Engstrom, and PP Meier

Abstract: Infants born at very low birth weight (VLBW; birth weight <1500 g) are at high risk of mortality and are some of the most expensive patients in the hospital. Additionally, VLBW infants are susceptible to prematurity-related morbidities, including late-onset sepsis, bronchopulmonary dysplasia (BPD), necrotizing enterocolitis, and retinopathy of prematurity, which have short- and long-term economic consequences. The incremental cost of these morbidities during the neonatal intensive care unit (NICU) hospitalization is high, ranging from $10,055 (in 2009 US$) for late-onset sepsis to $31,565 for BPD. Human milk has been shown to reduce both the incidence and severity of some of these morbidities and, therefore, has an indirect impact on the cost of the NICU hospitalization. Furthermore, human milk may also directly reduce NICU hospitalization costs, independent of the indirect impact on the incidence and/or severity of these morbidities. Although there is an economic cost to both the mother and institution for providing human milk during the NICU hospitalization, these costs are relatively low. This review describes the total cost of the initial NICU hospitalization, the incremental cost associated with these prematurity-related morbidities, and the incremental benefits and costs of human milk feedings during critical periods of the NICU hospitalization as a strategy to reduce the incidence and severity of these morbidities. Adv. Nutr. 5: 207–212, 2014. 

original article - Economic Benefits and Costs 2014 - Advances in Nutrition

return to top