Improved outcomes and reduced costs: Exclusive human milk diet for very low birth weight infants at a single center
Gabriella Mudekunye, Zoe Tullius, Cynthia A Guevara, Amanda Timmerman, Gyan Moorthy, Martin Lee, Sireesha Reddy, Sadhana ChhedaBackground
Very low birth weight (VLBW, <1500 g) infants are at increased risk for necrotizing enterocolitis (NEC) and other morbidities. An exclusive human milk diet (EHMD) may reduce complications compared with bovine fortifier or formula, but its clinical and economic benefits remain debated.
Aim
To evaluate the impact of EHMD implementation on clinical outcomes and healthcare resource utilization in VLBW infants at a single center.
Methods
This retrospective cohort study included VLBW infants admitted to El Paso Children's Hospital from February 2012 to September 2019. The pre-EHMD group (2012–2014, n = 104) received preterm formula or bovine fortifier, while the EHMD group (2014–2019, n = 225) received mother's or donor human milk with human milk-based fortifier until 34 weeks postmenstrual age. Outcomes included NEC, parenteral nutrition (PN) and antibiotic days, central line use, blood transfusions, growth, and healthcare costs.
Summary
Despite lower gestational age and birth weight, the EHMD group had significantly lower rates of NEC (12.5% vs. 4.9%) and surgical NEC (8.7% vs. 3.1%), as well as fewer PN, antibiotic, and central line days and fewer blood transfusions. Periventricular leukomalacia was also reduced (26.9% vs. 19.6%), while growth outcomes were comparable. Although EHMD had higher upfront costs, overall resource savings yielded a favorable cost-benefit ratio of 1.83. These findings support EHMD as a clinically effective and economically advantageous strategy for VLBW infants.