Cost Savings of Human Milk as a Strategy to Reduce the Incidence of Necrotizing Enterocolitis in Very Low Birth Weight Infants

Johnson, Tricia J.; Patel, Aloka L.; Bigger, Harold R.; Engstrom, Janet L.; Meier, Paula P.

doi:10.1159/000370058

Cited by 115 publications

(110 citation statements)

References 28 publications

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“…The length of hospital stay (LOS) is considerably longer for NEC patients than infants without NEC. One study that evaluated 291 VLBW infants found that LOS was much longer for infants with NEC than without (85 6 36 d compared with 70 6 33 d, respectively) (13). Another study reported similar differences in LOS, in which infants with NEC had a mean incremental LOS of 11.7 d (95% CI: 6.9, 16.5) compared with infants without NEC (16).…”

Section: Necmentioning

confidence: 98%

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Current Knowledge of Necrotizing Enterocolitis in Preterm Infants and the Impact of Different Types of Enteral Nutrition Products

Shulhan¹,

Dicken²,

Hartling³

et al. 2017

Advances in Nutrition

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Preterm infants are extremely vulnerable to a range of morbidities and mortality. Underdeveloped cardiac, respiratory, gastrointestinal, and immune systems in the preterm period increase the risk of necrotizing enterocolitis (NEC), a serious disease of the gut. NEC affects 5-12% of very-low birthweight infants, leads to surgery in 20-40% of cases, and is fatal in 25-50% of cases. There are multiple factors that may contribute to NEC, but the exact cause is not yet fully understood. Severe cases can result in intestinal resection or death, and the health care costs average >$300,000/infant when surgical management is required. Different types of nutrition may affect the onset or progression of NEC. Several studies have indicated that bovine milk-based infant formulas lead to a higher incidence of NEC in preterm infants than does human milk (HM). However, it is not clear why HM is linked to a lower incidence of NEC or why some infants fed an exclusively HM diet still develop NEC. An area that has not been thoroughly explored is the use of semielemental or elemental formulas. These specialty formulas are easy to digest and absorb in the gut and may be an effective nutritional intervention for reducing the risk of NEC. This review summarizes what is known about the factors that contribute to the onset and progression of NEC, discusses its health care cost implications, and explores the impact that different formulas and HM have on this disease. Adv Nutr 2017;8:80-91.

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Section: Necmentioning

confidence: 98%

“…The incidence of NEC across developed countries is ;5-12% for VLBW infants (13)(14)(15)(16)(17)(18), depending on certain risk factors. Three major risk factors for NEC are <32 wk gestational age, <1500 g at birth, and cardiac complications (10).…”

Section: Necmentioning

confidence: 99%

Current Knowledge of Necrotizing Enterocolitis in Preterm Infants and the Impact of Different Types of Enteral Nutrition Products

Shulhan¹,

Dicken²,

Hartling³

et al. 2017

Advances in Nutrition

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“…Details of inclusion and exclusion criteria have been previously described. 2,4,10,11 In cases of multiple births, one infant was randomly selected for study inclusion. In addition, initiation of lactation was not a criterion for study enrollment for either infant or the mother.…”

Section: Samplementioning

confidence: 99%

“…[2][3][4] Mothers of VLBW infants admitted to the neonatal intensive care unit (NICU) face unique barriers to exclusive breastfeeding when compared to mothers of term infants, especially the inability of the infant to feed directly at the breast and long-term breast pump dependency 5,6 Beyond the barriers affecting all mothers of VLBW infants, most studies report a significant racial disparity with fewer black mothers of VLBW infants initiating and/or continuing HM feeding at NICU discharge compared to non-black mothers (Fig. 1).…”

Section: Introductionmentioning

confidence: 99%

Barriers to Human Milk Feeding at Discharge of Very Low–Birthweight Infants: Evaluation of Neighborhood Structural Factors

Riley

Schoeny

Rogers

et al. 2016

Breastfeeding Medicine

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Background: Although 98% of mothers in our cohort initiated human milk (HM) provision for their very lowbirthweight (VLBW) infants, fewer black infants received HM at neonatal intensive care unit (NICU) discharge than non-black infants. This study examined neighborhood structural factors associated with HM feeding at discharge to identify potential barriers. Materials and Methods: Sociodemographic and HM data were prospectively collected for 410 VLBW infants and mothers. Geocoded addresses were linked to neighborhood structural factors. Bivariate and multivariate logistic regression analyses were conducted for the entire cohort and racial/ethnic subgroups. Results: HM feeding at discharge was positively correlated with further distance from Women, Infants, and Children (WIC) office, less violent crime, less poverty, greater maternal education, older maternal age, greater infant gestational age, and shorter NICU hospitalization. Multivariate analysis demonstrated that only maternal race/ethnicity, WIC eligibility, and length of NICU hospitalization predicted HM feeding at discharge for the entire cohort. The interaction between access to a car and race/ethnicity significantly differed between black and white/Asian mothers, although the predicted probability of HM feeding at discharge was not significantly affected by access to a car for any racial/ethnic subgroup. Conclusions: Neighborhood structural factors did not significantly impact HM feeding at discharge. However, lack of access to a car may be a factor for black mothers, potentially representing restricted HM delivery to the NICU or limited social support, and warrants further study.

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“…It is the most common gastrointestinal emergency in the newborn (1)(2)(3)5,6), more frequent in the preterm infant, especially those of very low weight [newborns with birth weight <1,500 g or very low birth weight (VLBW)], although it affects term infants also (5,(7)(8)(9)(10). The incidence of NEC in VLBW infants, stable over the years, is between 5-7% (11,12); a slight increase over the period [2000][2001][2002][2003][2004][2005][2006][2007][2008][2009] was reported in the intensive care unit neonatal (NICU) of the Vermont Oxford Network (VON) (12). Recently in UK an incidence of around 3% in infants <32 weeks' Review Article Diagnostic imaging features of necrotizing enterocolitis: a narrative review gestational age, between 2012 and 2013, was reported (13).…”

Section: Introductionmentioning

confidence: 99%

Diagnostic imaging features of necrotizing enterocolitis: a narrative review

Esposito¹,

Mamone²,

Serafino³

et al. 2017

Quant. Imaging Med. Surg.

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Necrotizing enterocolitis (NEC) is an inflammatory process, characterized by intestinal necrosis of variable extension, leading to perforation, generalized peritonitis and death. The classical pathogenetic theory focuses on mucosal damage related to a stress induced intestinal ischemia leading to mucosal injury and bacterial colonization of the wall. A more recent hypothesis emphasizes the role of immaturity of gastrointestinal and immune system, particularly of the premature, responsible of bowel wall vulnerability and suffering. NEC is the most common gastrointestinal emergency in the newborn, with a higher incidence in the preterm; improvement of neonatal resuscitation techniques enables the survival of premature of very low birth weight (VLBW) with prolongation of hospital stay for perinatal and neonatal care and a higher risk of NEC. Clinical presentation of NEC in newborn ranges from mild forms with moderate gastrointestinal tract disorder and that can heal spontaneously, to very serious forms with fulminant course characterized by perforation, peritonitis, sepsis, disseminated intravascular coagulation (DIC) and shock. Imaging modality in the diagnosis of NEC is historically represented by the plain-film abdominal radiographs which can be performed every 6 hours because of the rapid evolution that may occur in the patient's clinical condition.However ultrasound (US), in recent years, is playing an increasingly important role in the evaluation of early stages of the disease as it provides images in real time of the abdominal structures being able to assess the presence and validity of peristalsis of the bowel loops, detect the thickness of the intestinal wall and the presence of minimal amounts of fluid in the peritoneal cavity. In this paper we review the pathogenesis, clinical presentation and imaging of NEC with a particular attention to the emergent role of US in the diagnosis of the disease.

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Cost Savings of Human Milk as a Strategy to Reduce the Incidence of Necrotizing Enterocolitis in Very Low Birth Weight Infants

Cited by 115 publications

References 28 publications

Current Knowledge of Necrotizing Enterocolitis in Preterm Infants and the Impact of Different Types of Enteral Nutrition Products

Current Knowledge of Necrotizing Enterocolitis in Preterm Infants and the Impact of Different Types of Enteral Nutrition Products

Barriers to Human Milk Feeding at Discharge of Very Low–Birthweight Infants: Evaluation of Neighborhood Structural Factors

Diagnostic imaging features of necrotizing enterocolitis: a narrative review

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