The Economic Impact of Donor Milk in the Neonatal Intensive Care Unit.

OBJECTIVE: To assess the cost-effectiveness of mother's own milk supplemented with donor milk vs mother's own milk supplemented with formula for infants of very low birth weight in the neonatal intensive care unit (NICU). STUDY DESIGN: A retrospective analysis of 319 infants with very low birth weight born before (January 2011-December 2012, mother's own milk + formula, n = 150) and after (April 2013-March 2015, mother's own milk + donor milk, n = 169) a donor milk program was implemented in the NICU. Data were retrieved from a prospectively collected research database, the hospital's electronic medical record, and the hospital's cost accounting system. Costs included feedings and other NICU costs incurred by the hospital. A generalized linear regression model was constructed to evaluate the impact of feeding era on NICU total costs, controlling for neonatal and sociodemographic risk factors and morbidities. An incremental cost-effectiveness ratio was calculated for each morbidity that differed significantly between feeding eras. RESULTS: Infants receiving mother's own milk + donor milk had a lower incidence of necrotizing enterocolitis (NEC) than infants receiving mother's own milk + formula (1.8% vs 6.0%, P = .048). Total (hospital + feeding) median costs (2016 USD) were $169 555 for mother's own milk + donor milk and $185 740 for mother's own milk + formula (P = .331), with median feeding costs of $1317 and $936, respectively (P < .001). Mother's own milk + donor milk was associated with $15 555 lower costs per infant (P = .045) and saved $1812 per percentage point decrease in NEC incidence. CONCLUSIONS: The additional cost of a donor milk program was small compared with the cost of a NICU hospitalization. After its introduction, the NEC incidence was significantly lower with small cost savings per case. We speculate that NICUs with greater NEC rates may have greater cost savings.

Implementation of the Reimbursement Cost of Human-Milk-Based Neonatal Therapy in Polish Health Care Service : Practical and Ethical Background.

BACKGROUND: A human-milk-based diet is the best option for nutritional therapy for preterm and/or sick newborns. RESEARCH AIM: The study aims were to restructure the reimbursement rates to hospitals in Poland for infants' tube feedings to favor the use of donor human milk over formula for newborns who required supplementation of expressed mother's milk and evaluate the results of the financing change during the first year of implementation (2018). METHODS: Financial data from hospitals were collected (2015-2016) by the Human Milk Bank Foundation using a data sheet designed by the Agency for Health Technology Assessment and Tariff System. We used data to restructure the reimbursement rates to hospitals for infants' tube feedings and implemented the changes in late 2017. The National Health Fund was requested to share reported data in 2018 concerning tube feeding services. RESULTS: More than half (61%) of NICUs introduced human milk tube feeding for newborns. It was provided to participants (N = 5,530), most frequently to seriously ill preterm infants (66.6%). Of these infants, 2,323 were fed donor human milk. Only 1,925 newborns received formula tube feeding. However, there were large differences in frequency of services reported among various parts of the country. CONCLUSIONS: Based on our knowledge, Poland is the only European country where the reimbursement cost for human-milk-based nutritional therapy has been implemented in a manner intended to increase the quality of health care services for preterm newborns. Equal reimbursement for expressed mother's milk and donor milk did not appear to cause overuse of donor milk based on our analysis of the 2018 data.

Cost Analysis of Operating a Human Milk Bank in China.

BACKGROUND: Establishing a human milk bank for the benefit of premature newborns who are unable to receive their mothers' milk for various reasons is a common initiative. To date, 19 human milk banks have been established in China; however, data associated with human milk banks are lacking, including information on the operational costs, guidelines, and regulatory systems for human milk banks in China. RESEARCH AIM: Our study aim was to conduct a cost analysis for the human milk bank at Shanghai Children's Hospital. METHODS: A management accounting approach, based on the activity-based costing method, was used to develop a cost model for donor human milk. The data were collected retrospectively and included budget plans, financial and expenditure reports, databases, and interviews with the staff and managers at the Shanghai Children's Hospital Human Milk Bank in 2017. RESULTS: In 2017, the total volume of qualified donor human milk was 933.70 L, of which 842.71 L (90%) was frozen and 90.99 L (10%) was freshly donated on site. The total annual cost to provide milk for 212 high-risk infants in 2017 was US$156,923, and the unit cost was US$168/L. CONCLUSIONS: The operating costs of human milk banks in China are similar to those in other countries internationally, but these costs are so large that they require government and society support for funding and milk donation. Therefore, ongoing breastfeeding support for mothers and measures to reduce the operating costs of human milk banks should be advocated.

Advocating for Pasteurized Donor Human Milk: The Journey for Medicaid Reimbursement in New York State.

BACKGROUND: The American Academy of Pediatrics and the National Association of Neonatal Nurses recognize that federal policies fail to reimburse for the provision of pasteurized donor human milk (PDHM) to the very low birth-weight neonate, and have encouraged members to advocate for the inclusion of PDHM into their respective state Medicaid programs. PURPOSE: This article describes what occurred in New York State as advocates worked for reimbursement of PDHM reimbursement by Medicaid. METHOD: Tactics utilized in New York have been presented with an advocacy framework to illustrate the necessary strategic foresight required for productive engagement within the healthcare policy arena. RESULTS: Examination of employed advocacy efforts targeted to remove known cost barriers associated with PDHM. IMPLICATIONS FOR PRACTICE: Full utilization of PDHM within intensive care. IMPLICATIONS FOR FUTURE RESEARCH: The necessity to engage in scholastic/evidence-based advocacy work.

Captação e aproveitamento de leite humano em um banco de leite de um município do Estado do Paraná / Captura y utilización de leche humana en un banco de leche un municipio del Estado de Paraná / Human milk collection and utilization in a milk bank from a municipality of Paraná state

Objetivo: Descrever a captação, aproveitamento e o perfil das doadoras de Leite Humano em um Banco de leite de um município do Estado do Paraná. Métodos: Estudo epidemiológico de corte transversal com abordagem quantitativa. Os dados foram coletados entre janeiro e fevereiro de 2015, a partir de fichas arquivadas no primeiro ano de funcionamento, 2013-2014. Resultados: As doadoras eram da faixa etária de 26 a 32 anos, casadas, do lar, tinham 1 ou 2 filhos, foram indicadas por serviços de saúde e a principal motivação para a doação foi o excesso de leite. A média de leite doado foi de 1,4 litros, a maioria na fase madura. Houve perda significativa de leite devido a sujidade. Conclusão: Faz-se necessário, o desenvolvimento de ações para a captação de doadoras, para diminuição das perdas de leite e para educação permanente dos profissionais de saúde envolvidos, a fim de otimizar o funcionamento do serviço

Objetivo: Describir la recopilación, el uso y el perfil de la leche humana de donantes en un banco de leche una ciudad de Paraná. Metodos: Estudio epidemiológico de corte transversal con enfoque cuantitativo. Los datos fueron recogidos entre enero y febrero de 2015, a partir de registros archivados en el primer año de funcionamiento, 2013-2014. Resultados: Los donantes eran del grupo de edad de 26-32 años de edad, casado, tenía su casa 1 o 2 niños, fueron indicados por servicios de salud y la principal motivación para la donación fue el exceso de leche. La leche donada promedio fue de 1,4 litros, sobre todo en la fase de madurez. Había una pérdida significativa de la leche debido a la suciedad. Conclusión: Es necesario, por el desarrollo de acciones para atraer donantes para reducir la pérdida de la leche y la educación de los profesionales de la salud involucrados con el fin de optimizar el funcionamiento del servicio de continuar

Objective: The study's goal has been to describe the collection, utilization and profile of human milk donors in a milk bank of a municipality of Paraná State. Methods: It is a cohort epidemiological study with quantitative approach. Data were collected from January to February 2015, based on records filed in the first year of operation, 2013-2014. Results: Donors belonged to age group from 26 to 32 years old; they were married; they had either 1 or 2 children, and have been indicated by health services, where the primary motivation for the donation was the breast milk excess. The donated milk average amount was 1.4 liter (most in the mature phase). There was a significant loss of milk due to dirtiness. Conclusion: It is necessary the development of actions in order to attract donors, reduce milk loss and provide ongoing education for the health professionals involved, aiming to optimize the service operation

Medicine, Body Fluid and Food: The Regulation of Human Donor Milk in Canada.

The use of peer-to-peer online networks to access both pasteurized and unpasteurized human donor milk is increasing in Canada. In the absence of a mother's own milk, donor milk is the next best nutrition available for all infants in need of supplementation. Limited supply and the cost of pasteurized milk puts it out of reach for many. Although milk banks in Canada all operate on a non-profit basis, there is a lack of regulatory safeguards regarding for-profit operations and private milk exchange. This paper describes regulation of human donor milk and identifies gaps putting families at risk.

[Satellite center of human milk: Analysis of cost reduction]. / Centro satélite de donación y recepción de leche materna como alternativa a la creación de un banco de leche independiente. Análisis de reducción de costes.

INTRODUCTION: Donor milk is the second best alternative for a newborn after the mother's own milk, especially when the baby is a premature or a sick child since this milk has the advantage of protecting against necrotizing enterocolitis. There are currently 13 milk banks in Spain, however this is not sufficient to supply all Spanish neonatal units with donor milk. In order to bring donor milk to the babies in Neonatal Unit of the Regional University Hospital of Malaga, a Satellite Centre (CS) was created in 2012, depending on the Milk Bank of Virgen de las Nieves Hospital in Granada. AIM: Assessing the efficiency of a SC compared to an independent milk bank. METHOD: A study of cost minimization is used for the analysis. The cost of the implementation of the SC is calculated and compared to the cost of the implementation of the Milk Bank of Virgen de las Nieves of Granada. Additionally, the maintenance cost per year of the 2 models is compared, taking into account the running phase from June, 2012 through August 2015 in the SC. RESULTS: A SC implies savings of 88,852 Euro in equipment, and 24,572 Euro per year in maintenance compared to an independent milk bank. CONCLUSIONS: The efficiency of the SC is due to a better use of resources. A distribution network model of donor human milk, consisting of milk banks and SC, makes it possible to equally supply human milk to premature infants with a reduced cost.

Cost and Use of Pasteurized Donor Human Milk at a Children's Hospital.

OBJECTIVE: To determine the cost and use of pasteurized donor human milk (PDHM) at a children's hospital with a strong human milk culture. DESIGN: A retrospective descriptive cohort study. SETTING: A children's hospital in the northeastern region of the United States. PARTICIPANTS: Infants (N = 281) younger than 1 year of age at the time of hospitalization who received PDHM between January 2011 and November 2014. Infants older than 1 year of age at the time of hospitalization were excluded from the study sample. METHODS: For each eligible infant, the following descriptive characteristics were abstracted from the electronic health record: gestational age, birth weight, primary diagnosis, unit/floor, total volume of PDHM fed to infant, total number of days the infant received PDHM, diet order on day of discharge, and total length of stay in days. Descriptive statistics were used to analyze all data. RESULTS: Of the sample, 70% (n = 197/281) were cared for in the NICU and 30% (n = 84/281) were cared for outside of the NICU. The mean number of days an infant received PDHM was 23 days (range = 1-134 days) and the mean volume consumed daily was 195 ml (range = 6-1,335 ml). Using a purchase cost of U.S. $4.50 per ounce, the average purchase cost of PDHM per day was U.S. $29.19 (range = U.S. $0.90 to U.S. $200.23). CONCLUSION: PDHM is a low-cost intervention compared with many other interventions for the care of hospitalized infants.

Cost and Cost-Effectiveness of Donor Human Milk to Prevent Necrotizing Enterocolitis: Systematic Review.

BACKGROUND: Necrotizing enterocolitis (NEC) is a costly gastrointestinal disorder that mainly affects preterm and low-birth-weight infants and can lead to considerable morbidity and mortality. Mother's own milk is protective against NEC but is not always available. In such cases, donor human milk has also been shown to be protective (although to a lesser extent) compared with formula milk, but it is more expensive. This systematic review aimed at evaluating the cost of donor milk, the cost of treating NEC, and the cost-effectiveness of exclusive donor milk versus formula milk feeding to reduce the short-term health and treatment costs of NEC. MATERIALS AND METHODS: We systematically searched five relevant databases to find studies with verifiable costs or charges of donor milk and/or treatment of NEC and any economic evaluations comparing exclusive donor milk with exclusive formula milk feeding. All search results were double screened. RESULTS: Seven studies with verifiable donor milk costs and 17 with verifiable NEC treatment costs were included. The types of cost or charge included varied considerably across studies, so quantitative synthesis was not attempted. Estimates of the incremental length of stay associated with NEC were ∼18 days for medical NEC and 50 days for surgical NEC. Two studies claimed to report economic evaluations but did not do so in practice. CONCLUSIONS: It is likely that donor milk provides short-term cost savings by reducing the incidence of NEC. Future studies should provide more details on cost components included and a full economic evaluation, including long-term outcomes, should be undertaken.

Decreased cost and improved feeding tolerance in VLBW infants fed an exclusive human milk diet.

OBJECTIVE: Human milk is the best form of nutrition for preterm infants and has been associated with a lower incidence of necrotizing enterocolitis (NEC). Infants that develop NEC have a higher incidence of feeding intolerance and longer hospitalizations. The combination of a donor milk bank and donor milk-derived fortifier has changed feeding practices in neonatal intensive care units (NICU). The purpose of this study is to assess the benefits and cost of an exclusive human milk (EHM) diet in very low birth weight (VLBW) infants in a community level III NICU. STUDY DESIGN: This is a retrospective study including preterm infants ⩽28 weeks and/or VLBW (⩽1500 g) who were enrolled from March 2009 until March 2014. Infants were grouped as follows: group H (entirely human milk based, born March 2012 to 2014), group B (bovine-based fortifier and maternal milk, born March 2009 to 2012), group M (mixed combination of maternal milk, bovine-based fortifier and formula, born March 2009 to 2012) and group F (formula fed infants, born March 2009 to 2012). Baseline characteristics among the four groups were similar. RESULT: The study included 293 infants between gestational ages 23 to 34 weeks and birth weights between 490 and 1700 g. Feeding intolerance occurred less often (P<0.0001), number of days to full feeds was lower (P<0.001), incidence of NEC was lower (P<0.011), and total hospitalization costs were lower by up to $106,968 per infant (P<0.004) in those fed an EHM diet compared with the other groups. Average weight gain per day was similar among the four groups (18.5 to 20.6 g per day). CONCLUSIONS: Implementing an EHM diet in our VLBW infants has led to a significant decrease in the incidence of NEC. Other benefits of this diet include: decreased feeding intolerance, shorter time to full feeds, shorter length of stay, and lower hospital and physician charges for extremely premature and VLBW infants.

Demonstrating the efficacy of the FoneAstra pasteurization monitor for human milk pasteurization in resource-limited settings.

UNLABELLED: Human milk provides crucial nutrition and immunologic protection for infants. When a mother's own milk is unavailable, donated human milk, pasteurized to destroy bacteria and viruses, is a lifesaving replacement. Flash-heat pasteurization is a simple, low-cost, and commonly used method to make milk safe, but currently there is no system to monitor milk temperature, which challenges quality control. FoneAstra, a smartphone-based mobile pasteurization monitor, removes this barrier by guiding users through pasteurization and documenting consistent and safe practice. This study evaluated FoneAstra's efficacy as a quality control system, particularly in resource-limited settings, by comparing bacterial growth in donor milk flash-heated with and without the device at a neonatal intensive care unit in Durban, South Africa. MATERIALS AND METHODS: For 100 samples of donor milk, one aliquot each of prepasteurized milk, milk flash-heated without FoneAstra, and milk pasteurized with FoneAstra was cultured on routine agar for bacterial growth. Isolated bacteria were identified and enumerated. RESULTS: In total, 300 samples (three from each donor sample) were analyzed. Bacterial growth was found in 86 of the 100 samples before any pasteurization and one of the 100 postpasteurized samples without FoneAstra. None of the samples pasteurized using FoneAstra showed bacterial growth. CONCLUSIONS: Both pasteurization methods were safe and effective. FoneAstra, however, provides the additional benefits of user-guided temperature monitoring and data tracking. By improving quality assurance and standardizing the pasteurization process, FoneAstra can support wide-scale implementation of human milk banks in resource-limited settings, increasing access and saving lives.

Microbial contamination of human milk purchased via the Internet.

OBJECTIVE: To quantify microbial contamination of human milk purchased via the Internet as an indicator of disease risk to recipient infants. METHODS: Cross-sectional sample of human milk purchased via a popular US milk-sharing Web site (2012). Individuals advertising milk were contacted to arrange purchase, and milk was shipped to a rented mailbox in Ohio. The Internet milk samples (n = 101) were compared with unpasteurized samples of milk donated to a milk bank (n = 20). RESULTS: Most (74%) Internet milk samples were colonized with Gram-negative bacteria or had >10(4) colony-forming units/mL total aerobic count. They exhibited higher mean total aerobic, total Gram-negative, coliform, and Staphylococcus sp counts than milk bank samples. Growth of most species was positively associated with days in transit (total aerobic count [log10 colony-forming units/mL] ß = 0.71 [95% confidence interval: 0.38-1.05]), and negatively associated with number of months since the milk was expressed (ß = -0.36 [95% confidence interval: -0.55 to -0.16]), per simple linear regression. No samples were HIV type 1 RNA-positive; 21% of Internet samples were cytomegalovirus DNA-positive. CONCLUSIONS: Human milk purchased via the Internet exhibited high overall bacterial growth and frequent contamination with pathogenic bacteria, reflecting poor collection, storage, or shipping practices. Infants consuming this milk are at risk for negative outcomes, particularly if born preterm or are medically compromised. Increased use of lactation support services may begin to address the milk supply gap for women who want to feed their child human milk but cannot meet his or her needs.

Buying human milk via the internet: just a click away.

BACKGROUND: For past centuries, infants have been fed the milk of mothers who are not their own by latching to another woman's breast. Today, the majority of lactating women use electric pumps to extract milk from their breasts; thus, an infant now may be fed another woman's milk via a bottle or cup. The Internet is an emerging avenue to acquire pumped human milk. The purpose of our study was to participate in and describe the process of buying milk via the Internet. Our goal is to help those involved with the clinical care, research, and public health policy of mothers and infants better understand that families may be buying milk in this way. SUBJECTS AND METHODS: We anonymously bought 102 human milk samples via the Internet. We characterized the outside box, packing materials, milk container, temperature and condition of the milk, and cost. RESULTS: We bought 2,131 ounces of milk at a total cost of $8,306. Eighty-nine percent of the milk arrived above the recommended frozen temperature of -20°C; 45% of it was even above the recommended refrigerator temperature (4°C). The mean surface temperature of the milk samples in each shipment was correlated with the cost of shipping, time in transit, and condition of the milk containers. CONCLUSIONS: The prevalence and potential risks of this practice currently are unknown. Research related to milk quality and infant outcomes related to milk buying via the Internet is urgently needed.