Impact of early human milk on sepsis and health-care costs in very low birth weight infants.
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.


METHODS
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 kg(-1) day(-1) (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, P=0.008). Increasing ADDHM-Days 1-28 was associated with significantly lower NICU costs.


CONCLUSIONS
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 kg(-1) day(-1), the odds of sepsis decreased by 19%. NICU costs were lowest in the VLBW infants who received the highest ADDHM-Days 1-28.
Department of Pediatrics, Rush University Medical Center, Chicago, IL 60612, USA. Aloka_Patel@Rush.edu
A L
AL
Patel
T J
TJ
Johnson
J L
JL
Engstrom
L F
LF
Fogg
B J
BJ
Jegier
H R
HR
Bigger
P P
PP
Meier
D017281:Cost of Illness; D003365:Costs and Cost Analysis; D005248:Feeding Methods; D005260:Female; D005865:Gestational Age; D017048:Health Care Costs; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000191:economics / Q000517:prevention & control*; D019102:Infant, Very Low Birth Weight; D007363:Intensive Care Units, Neonatal / Q000191:economics; D008297:Male; D008895:Milk, Human; D057216:Propensity Score; D011446:Prospective Studies; D018805:Sepsis / Q000191:economics / Q000517:prevention & control*