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

描述（由申请人提供）：一系列小型研究表明，母乳（HM）喂养可保护极低出生体重（VLBW;出生体重<1500 g）婴儿免受早产特异性疾病的影响，这些疾病成本高昂且具有障碍性。然而，以前的研究没有最终将人乳喂养与改善婴儿健康结果联系起来，并降低新生儿重症监护病房（NICU）对这一人群的护理成本，或者解决是否需要更长和/或关键时期的人乳喂养来实现这些有益的结果。在缺乏这一证据的情况下，提供人乳的费用，其中大部分是由母亲而不是公共和私人保险公司承担，成为极低出生体重婴儿的母亲开始和维持哺乳的障碍，他们不成比例地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查人乳喂养的剂量和暴露时间的自变量之间的关系，以及婴儿健康结局的因变量和极低出生体重婴儿在新生儿重症监护室（NICU）期间人乳喂养的成本节约。拟议的项目将跟踪600名来自不同种族和经济背景母亲的极低出生体重婴儿的前瞻性队列（40%非裔美国人; 40%非西班牙裔高加索人; 20%西班牙裔; 60%低收入）在整个NICU停留期间测试3个主要假设：高剂量和暴露于人乳喂养的较长和/或关键时期与1）死亡率和早产特异性发病率的相对风险较低有关; 2）缩短NICU住院时间和适当的婴儿生长; 3）降低NICU总费用。同意参加研究的合格婴儿及其母亲将在婴儿入住NICU时入组。在婴儿整个NICU住院期间，将以电子方式收集每次肠内喂养的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解决婴儿健康结局和成本因变量的数据，并将包括提供HM的短期成本，如吸奶器租金、HM储存容器数量和哺乳专家的访问，以及NICU医疗保健总成本。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。重要性：这项研究是第一个前瞻性研究，以检查剂量和暴露期的人乳喂养和婴儿健康结果和人乳喂养的成本之间的关系，为大样本的VLBW婴儿出生的代表性数量的非洲裔美国人和低收入妇女。这项研究的结果将很容易转化为这一弱势群体的卫生政策和NICU协议。项目叙述 相关性：这项研究是第一个前瞻性研究，以检查剂量和暴露期的人乳喂养和婴儿健康结果和人乳喂养的成本之间的关系，为大样本的VLBW婴儿出生的代表性数量的非洲裔美国人和低收入妇女。这项研究的结果将很容易转化为这一弱势群体的卫生政策和NICU协议。

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.