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. 2013 Jul;33(7):514-9.
doi: 10.1038/jp.2013.2. Epub 2013 Jan 31.

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

A L Patel  1 , T J Johnson, J L Engstrom, L F Fogg, B J Jegier, H R Bigger, P P Meier
Affiliations

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

A L Patel et al. J Perinatol. 2013 Jul.

Abstract

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.

Study design: 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.

Result: 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.

Conclusion: 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.

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Figures

Figure 1
Figure 1
Flow diagram of subject recruitment
Figure 2
Figure 2
Daily mean HM intake in three different ADDHM-Days1-28 dosing groups: • Less than 25mL/kg/d, n 57; □ 25-49.99,mL/kg/d, n 32; ▲ 50mL/kg/d or greater, n 86. Panel A. HM dose expressed as ADDHM (ml/kg/d). Panel B. HM dose expressed as a proportion of total enteral intake.
Figure 3
Figure 3
Adjusted survival curves for sepsis by ADDHM-Days1-28 over the first 28 days of life. Survival curves adjusted for propensity score.
See this image and copyright information in PMC

Comment in

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