Division of Neonatology, Department of Child Health, Women's and Children's Hospital, University of Missouri Health Care, Columbia, Missouri, USA.
Breastfeed Med. 2021 Oct;16(10):814-820. doi: 10.1089/bfm.2020.0345. Epub 2021 Aug 19.
Our level III neonatal intensive care unit (NICU) implemented the use of an exclusive human milk diet (EHD) and sought to determine its effect on the severe co-morbidities of preterm infants as well as the potential cost-savings due to the anticipated reduction in these co-morbidities. A retrospective cohort study was completed to determine if an EHD statistically decreased the rate of co-morbidities including length of stay (LOS), days on total parental nutrition (TPN), rates of late onset sepsis, necrotizing enterocolitis (NEC), bronchopulmonary dysplasia (BPD), and severe retinopathy of prematurity (ROP). An EHD significantly decreased the odds of severe ROP (adjusted odds-ratio (aOR)=0.349; 95%CI [0.156, 0.739]; =0.008) and late onset sepsis (aOR=0.323; 95%CI [0.123, 0.768]; =0.014). Analysis of cost-effectiveness of an EHD relative to a BSD based on the incremental costs of these co-morbidities determined the net loss in direct hospital costs per patient were estimated to be $420 in 2016 US dollars; however, given the long-term health-care costs and non-pecuniary damages from the co-morbidities of severe ROP and sepsis this net loss appears negligible. This study found that an EHD significantly decreased the odds of severe ROP and late onset sepsis; though not significant, there was a positive trend in decreasing cases of medical NEC; our surgical NEC rates dropped to 0. The benefits of human milk are vital, and the costs are nominal.
我们的三级新生儿重症监护病房（NICU）实施了纯母乳喂养（EHD），并试图确定其对早产儿严重合并症的影响，以及由于这些合并症预期减少而带来的潜在成本节约。进行了一项回顾性队列研究，以确定 EHD 是否在统计学上降低了包括住院时间（LOS）、全胃肠外营养（TPN）天数、晚发性败血症、坏死性小肠结肠炎（NEC）、支气管肺发育不良（BPD）和严重早产儿视网膜病变（ROP）等合并症的发生率。EHD 显著降低了严重 ROP 的几率（调整后的优势比（aOR）=0.349；95%CI [0.156, 0.739]；=0.008）和晚发性败血症（aOR=0.323；95%CI [0.123, 0.768]；=0.014）。EHD 相对于 BSD 的成本效益分析基于这些合并症的增量成本，确定每个患者的直接医院成本净损失估计为 2016 年 420 美元；然而，鉴于严重 ROP 和败血症合并症的长期医疗保健成本和非经济损失，这种净损失似乎微不足道。本研究发现，EHD 显著降低了严重 ROP 和晚发性败血症的几率；尽管没有显著意义，但 NEC 病例呈减少趋势；我们的手术 NEC 发生率降至 0。人乳的益处至关重要，而成本微不足道。
