Donor Milk Economical for VLBW Babies : A healthier supplement than formula, donor milk also saves this Connecticut hospital money.

Major Finding: Thirty-two VLBW babies consumed an average of 523.3 ounces of formula and 74.2 ounces of donor milk over a period of 6 months. If all the babies who needed to supplement their mother's milk got donor milk, they might need 1,200 ounces a year, and at $4.50 per ounce, the researchers extrapolated an annual cost of $5,400 per year.

Data Source: Analysis of data on 32 VLBW babies at one hospital.

Disclosures: Dr. Marinelli said she had nothing to disclose.

SAN FRANCISCO — Providing donor milk to infants with very low birth weights is proving both inexpensive and practical, according to researchers from the University of Connecticut.

“You save money, and you end up with healthier babies,” said Dr. Kathleen A. Marinelli, a neonatologist in the department of pediatrics at the university.

She estimated the cost of supplementing a very-low-birth-weight (VLBW) baby's diet with donor milk at $5,400 per year per infant.

Many previous studies have established the benefits of human milk for VLBW babies, and recent research has shown that donor milk is a healthier supplement than is formula when mothers can't provide all the milk their own children need.

One study of 207 extremely premature infants weighing 500-1,250 g at birth showed a 50% reduction in necrotizing enterocolitis and an almost 90% reduction in surgical necrotizing enterocolitis in infants whose mothers' milk was supplemented with human donor milk, compared with those whose mothers' milk was supplemented with bovine formula (J. Pediatr. 2010;156:562-7.e1).

Many mothers of VLBW infants can't produce all the milk their babies need. In particular, many can't express colostrum for the first few days.

To determine the practicality of supplementing the diets of these children with donor milk, Dr. Marinelli and colleagues at the Connecticut Children's Medical Center, Hartford, studied 32 babies who were born at the hospital with weights of less than 1,500 g for a period of 6 months.

They aimed to follow the NICU protocol of initiating enteral feeds by 48 hours of life, unless there was a reason for a delay. In practice, the mean hours to first feed was 61 +/− 45 hours, even after excluding those for whom feeds were intentionally held.

“My colleagues were very wrong when they said that we were following the protocol to the T,” said Dr. Marinelli, who is director of lactation support services at the hospital.

The problem, said Dr. Marinelli, is that babies born overnight may be well into their third day of life before rounds are made, and feeds are ordered and initiated.

The hospital has a strong breastfeeding culture, and of the 32 babies, only three of their mothers refused to try expressing milk. Another six tried without success or stopped for medical reasons.

The diets of 17 of the babies (53%) were at least 99% their mother's own milk. Of the four babies who received donor milk, one got 100% donor milk, one got 51%, one got 50%, and one got 21%, with the remainder of their milk coming from their mothers. Six babies fed on at least 99% formula, and six received a mixture of formula and their mother's milk.

Overall, the mothers were able to provide an average of 85% of the milk their babies needed. The babies in this study consumed an average of 74.2 ounces of donor milk and 523.3 ounces of formula. If all the babies who needed to supplement their mother's milk got donor milk, they might need 1,200 ounces a year, which at $4.50 per ounce would cost $5,400, the researchers estimated.

Dr. Marinelli and her colleagues at Connecticut Children's Medical Center estimated that the total cost to the hospital would be about $38,448 per year. Arguing that human milk has the potential to save the hospital much greater costs because healthier babies would need less care, they were able to convince administrators to make human milk the standard of care for babies born either weighing less than 1,800 g or at 34 weeks' gestational age, starting Aug. 1, 2010.

Dr. Marinelli said that donor milk is safe because donors are screened, and the milk is tested much in the same way that blood donations are screened and tested. But in addition, the milk is pasteurized. “There's never been an untoward effect,” she said. “It's cost effective, and it's life saving.”

Major Finding: Thirty-two VLBW babies consumed an average of 523.3 ounces of formula and 74.2 ounces of donor milk over a period of 6 months. If all the babies who needed to supplement their mother's milk got donor milk, they might need 1,200 ounces a year, and at $4.50 per ounce, the researchers extrapolated an annual cost of $5,400 per year.

Data Source: Analysis of data on 32 VLBW babies at one hospital.

Disclosures: Dr. Marinelli said she had nothing to disclose.

SAN FRANCISCO — Providing donor milk to infants with very low birth weights is proving both inexpensive and practical, according to researchers from the University of Connecticut.

“You save money, and you end up with healthier babies,” said Dr. Kathleen A. Marinelli, a neonatologist in the department of pediatrics at the university.

She estimated the cost of supplementing a very-low-birth-weight (VLBW) baby's diet with donor milk at $5,400 per year per infant.

Many previous studies have established the benefits of human milk for VLBW babies, and recent research has shown that donor milk is a healthier supplement than is formula when mothers can't provide all the milk their own children need.

One study of 207 extremely premature infants weighing 500-1,250 g at birth showed a 50% reduction in necrotizing enterocolitis and an almost 90% reduction in surgical necrotizing enterocolitis in infants whose mothers' milk was supplemented with human donor milk, compared with those whose mothers' milk was supplemented with bovine formula (J. Pediatr. 2010;156:562-7.e1).

Many mothers of VLBW infants can't produce all the milk their babies need. In particular, many can't express colostrum for the first few days.

To determine the practicality of supplementing the diets of these children with donor milk, Dr. Marinelli and colleagues at the Connecticut Children's Medical Center, Hartford, studied 32 babies who were born at the hospital with weights of less than 1,500 g for a period of 6 months.

They aimed to follow the NICU protocol of initiating enteral feeds by 48 hours of life, unless there was a reason for a delay. In practice, the mean hours to first feed was 61 +/− 45 hours, even after excluding those for whom feeds were intentionally held.

“My colleagues were very wrong when they said that we were following the protocol to the T,” said Dr. Marinelli, who is director of lactation support services at the hospital.

The problem, said Dr. Marinelli, is that babies born overnight may be well into their third day of life before rounds are made, and feeds are ordered and initiated.

The hospital has a strong breastfeeding culture, and of the 32 babies, only three of their mothers refused to try expressing milk. Another six tried without success or stopped for medical reasons.

The diets of 17 of the babies (53%) were at least 99% their mother's own milk. Of the four babies who received donor milk, one got 100% donor milk, one got 51%, one got 50%, and one got 21%, with the remainder of their milk coming from their mothers. Six babies fed on at least 99% formula, and six received a mixture of formula and their mother's milk.

Overall, the mothers were able to provide an average of 85% of the milk their babies needed. The babies in this study consumed an average of 74.2 ounces of donor milk and 523.3 ounces of formula. If all the babies who needed to supplement their mother's milk got donor milk, they might need 1,200 ounces a year, which at $4.50 per ounce would cost $5,400, the researchers estimated.

Dr. Marinelli and her colleagues at Connecticut Children's Medical Center estimated that the total cost to the hospital would be about $38,448 per year. Arguing that human milk has the potential to save the hospital much greater costs because healthier babies would need less care, they were able to convince administrators to make human milk the standard of care for babies born either weighing less than 1,800 g or at 34 weeks' gestational age, starting Aug. 1, 2010.

Dr. Marinelli said that donor milk is safe because donors are screened, and the milk is tested much in the same way that blood donations are screened and tested. But in addition, the milk is pasteurized. “There's never been an untoward effect,” she said. “It's cost effective, and it's life saving.”

Major Finding: Thirty-two VLBW babies consumed an average of 523.3 ounces of formula and 74.2 ounces of donor milk over a period of 6 months. If all the babies who needed to supplement their mother's milk got donor milk, they might need 1,200 ounces a year, and at $4.50 per ounce, the researchers extrapolated an annual cost of $5,400 per year.

Data Source: Analysis of data on 32 VLBW babies at one hospital.

Disclosures: Dr. Marinelli said she had nothing to disclose.

SAN FRANCISCO — Providing donor milk to infants with very low birth weights is proving both inexpensive and practical, according to researchers from the University of Connecticut.

“You save money, and you end up with healthier babies,” said Dr. Kathleen A. Marinelli, a neonatologist in the department of pediatrics at the university.

She estimated the cost of supplementing a very-low-birth-weight (VLBW) baby's diet with donor milk at $5,400 per year per infant.

Many previous studies have established the benefits of human milk for VLBW babies, and recent research has shown that donor milk is a healthier supplement than is formula when mothers can't provide all the milk their own children need.

One study of 207 extremely premature infants weighing 500-1,250 g at birth showed a 50% reduction in necrotizing enterocolitis and an almost 90% reduction in surgical necrotizing enterocolitis in infants whose mothers' milk was supplemented with human donor milk, compared with those whose mothers' milk was supplemented with bovine formula (J. Pediatr. 2010;156:562-7.e1).

Many mothers of VLBW infants can't produce all the milk their babies need. In particular, many can't express colostrum for the first few days.

To determine the practicality of supplementing the diets of these children with donor milk, Dr. Marinelli and colleagues at the Connecticut Children's Medical Center, Hartford, studied 32 babies who were born at the hospital with weights of less than 1,500 g for a period of 6 months.

They aimed to follow the NICU protocol of initiating enteral feeds by 48 hours of life, unless there was a reason for a delay. In practice, the mean hours to first feed was 61 +/− 45 hours, even after excluding those for whom feeds were intentionally held.

“My colleagues were very wrong when they said that we were following the protocol to the T,” said Dr. Marinelli, who is director of lactation support services at the hospital.

The problem, said Dr. Marinelli, is that babies born overnight may be well into their third day of life before rounds are made, and feeds are ordered and initiated.

The hospital has a strong breastfeeding culture, and of the 32 babies, only three of their mothers refused to try expressing milk. Another six tried without success or stopped for medical reasons.

The diets of 17 of the babies (53%) were at least 99% their mother's own milk. Of the four babies who received donor milk, one got 100% donor milk, one got 51%, one got 50%, and one got 21%, with the remainder of their milk coming from their mothers. Six babies fed on at least 99% formula, and six received a mixture of formula and their mother's milk.

Overall, the mothers were able to provide an average of 85% of the milk their babies needed. The babies in this study consumed an average of 74.2 ounces of donor milk and 523.3 ounces of formula. If all the babies who needed to supplement their mother's milk got donor milk, they might need 1,200 ounces a year, which at $4.50 per ounce would cost $5,400, the researchers estimated.

Dr. Marinelli and her colleagues at Connecticut Children's Medical Center estimated that the total cost to the hospital would be about $38,448 per year. Arguing that human milk has the potential to save the hospital much greater costs because healthier babies would need less care, they were able to convince administrators to make human milk the standard of care for babies born either weighing less than 1,800 g or at 34 weeks' gestational age, starting Aug. 1, 2010.

Dr. Marinelli said that donor milk is safe because donors are screened, and the milk is tested much in the same way that blood donations are screened and tested. But in addition, the milk is pasteurized. “There's never been an untoward effect,” she said. “It's cost effective, and it's life saving.”