Health Benefits and Cost of Human Milk Feedings for Very Low Birthweight Infants

描述(由申请人提供)：一系列小规模研究表明，母乳喂养可以保护极低出生体重(VLBW；出生体重和1500克)婴儿免受成本高昂且有障碍的早产儿特有疾病的影响。然而，以前没有研究明确地将HM喂养与改善婴儿健康结果和降低这一人群的新生儿重症监护病房(NICU)护理成本联系在一起，也没有研究解决是否需要更长和/或关键时期的HM喂养来实现这些有益的结果。在缺乏这一证据的情况下，提供保健服务的费用，其中大部分由母亲承担，而不是由公共和私营保险公司承担，成为极低出生体重婴儿的母亲开始和维持哺乳的障碍，这些母亲极有可能是低收入和非裔美国人。这项为期5年的研究的总体目标是检验HM喂养剂量和暴露时间的自变量之间的关系，以及VLBW婴儿在新生儿重症监护病房(NICU)期间使用HM喂养的婴儿健康结局和费用节省的因变量之间的关系。拟议的项目将遵循600名由不同种族和经济背景的母亲(40%的非裔美国人；40%的非西班牙裔高加索人；20%的西班牙裔；60%的低收入者)出生的VLBW婴儿在整个NICU住院期间出生的前瞻性队列，以检验3个主要假设：更高的剂量和更长的和/或关键时期的HM喂养与1)较低的死亡率和早产儿特有的发病率相关；2)较短的NICU停留时间和适当的婴儿生长；以及3)较低的NICU总成本。同意参加研究的符合条件的婴儿及其母亲将在婴儿进入NICU时登记。在婴儿整个NICU期间的每一次肠道喂养中，将以电子方式收集HM喂养剂量和暴露时间的自变量数据。将定期以电子方式收集婴儿健康结局和费用的相关变量的数据，其中将包括提供HM的短期费用，如吸奶器租金、HM储存容器的数量、与哺乳专家的接触情况，以及NICU医疗保健总费用。统计分析将包括结构方程建模、风险分析、多元回归分析和成本效益分析。意义：这项研究是第一次研究HM喂养剂量和暴露时间与婴儿健康结局和HM喂养成本之间的关系的前瞻性研究，对象是具有代表性的非裔美国人和低收入妇女所生的极低出生体重儿的大样本。这项研究的结果将很容易转化为针对这一弱势群体的卫生政策和NICU方案。项目叙事 相关性：这项研究是第一次研究HM喂养剂量和暴露时间与婴儿健康结局和HM喂养成本之间的关系的前瞻性研究，对象是具有代表性的非裔美国人和低收入妇女所生的极低出生体重儿的大样本。这项研究的结果将很容易转化为针对这一弱势群体的卫生政策和NICU方案。

DESCRIPTION (provided by applicant): A series of small studies has suggested that human milk (HM) feedings protect very low birthweight (VLBW; birthweight <1500 g) infants from prematurity-specific morbidities that are costly and handicapping. However, no previous research has conclusively linked HM feedings with improved infant health outcomes and lowers neonatal intensive care unit (NICU) cost of care for this population, or has addressed whether longer and/or critical periods of exposure to HM feedings are necessary to achieve these beneficial outcomes. In the absence of this evidence, the costs of providing HM, most of which are borne by mothers rather than public and private insurers, serve as barriers to the initiation and maintenance of lactation for mothers of VLBW infants, who are disproportionately likely to be low-income and African American. The overall objective of this 5-year study is to examine the relationship between the independent variables of dose and exposure period of HM feedings, and the dependent variables of infant health outcomes and cost savings of HM feedings for VLBW infants throughout their stay in the neonatal intensive care unit (NICU). The proposed project will follow a prospective cohort of 600 VLBW infants born to racially and economically diverse mothers (40 percent African American; 40 percent non-Hispanic Caucasian; 20 percent Hispanic; 60 percent low-income) throughout the NICU stay to test 3 major hypotheses: that higher doses and longer and/or critical periods of exposure to HM feedings are associated with 1) a lower relative risk of mortality and prematurity-specific morbidities; 2) shorter length of NICU stay and appropriate infant growth; and 3) lower total NICU costs. Eligible infants and their mothers who consent to participate in the study will be enrolled upon the infant's admission to the NICU. Data addressing the independent variables of dose and exposure period of HM feedings will be collected electronically for each enteral feeding throughout the infant's entire NICU stay. Data addressing the dependent variables of infant health outcomes and costs will be collected electronically at regular intervals, and will include the short-term costs of providing HM, such as breast pump rental, number of HM storage containers, and access to lactation experts, as well as total NICU health care costs. Statistical analyses will include structural equation modeling, risk analysis, multiple regression analysis, and cost-effectiveness analysis. Significance: This research is the first prospective study to examine the relationship between dose and exposure period of HM feedings and infant health outcomes and costs of HM feedings, for a large sample of VLBW infants born to representative numbers of African American and low-income women. The findings from this study will translate readily into health policy and NICU protocols for this vulnerable population. Project Narrative Relevance: This research is the first prospective study to examine the relationship between dose and exposure period of HM feedings and infant health outcomes and costs of HM feedings, for a large sample of VLBW infants born to representative numbers of African American and low-income women. The findings from this study will translate readily into health policy and NICU protocols for this vulnerable population.