title: Impact of Optimized Breastfeeding on the Costs of Necrotizing Enterocolitis in Extremely Low Birthweight Infants.
abstract: 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.
  
  
  
  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.
  
  
  
  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.
  
  
  
  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.
authors.affiliation: Carver College of Medicine, University of Iowa, Iowa City, IA. Electronic address: tarah-colaizy@uiowa.edu.
authors.forename: Tarah T
authors.initials: TT
authors.lastname: Colaizy
authors.affiliation: Department of Medicine, Cambridge Health Alliance and Harvard Medical School, Cambridge, MA.
authors.forename: Melissa C
authors.initials: MC
authors.lastname: Bartick
authors.affiliation: D'Youville College, Buffalo, NY.
authors.forename: Briana J
authors.initials: BJ
authors.lastname: Jegier
authors.affiliation: Department of Industrial Engineering, University of Pittsburgh, Pittsburgh, PA.
authors.forename: Brittany D
authors.initials: BD
authors.lastname: Green
authors.affiliation: Alliance for the Prudent Use of Antibiotics, Boston, MA.
authors.forename: Arnold G
authors.initials: AG
authors.lastname: Reinhold
authors.affiliation: Department of Computational and Applied Mathematics, Rice University, Houston, TX.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Schaefer
authors.affiliation: Department of Pediatrics, University of Pittsburgh, Pittsburgh, PA.
authors.forename: Debra L
authors.initials: DL
authors.lastname: Bogen
authors.affiliation: Department of Medicine, University of California, Davis, Davis, CA.
authors.forename: Eleanor Bimla
authors.initials: EB
authors.lastname: Schwarz
authors.affiliation: Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, NC; Carolina Global Breastfeeding Institute, Gillings School of Global Public Health, Chapel Hill, NC.
authors.forename: Alison M
authors.initials: AM
authors.lastname: Stuebe
mesh_terms: D001942:Breast Feeding / Q000191:economics*; D020345:Enterocolitis, Necrotizing / Q000191:economics* / Q000453:epidemiology / Q000517:prevention & control; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D041943:Infant Formula / Q000191:economics*; D052577:Infant, Extremely Low Birth Weight; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000191:economics* / Q000453:epidemiology / Q000517:prevention & control; D008895:Milk, Human; D018803:Models, Economic; D009010:Monte Carlo Method; D014481:United States / Q000453:epidemiology
keywords: economic analysis; human milk; monte carlo modeling; necrotizing enterocolitis