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）喂养可以保护极低出生体重（VLBW；出生体重<1500 g）的婴儿免受早产特异性疾病的影响，这些疾病既昂贵又致残。然而，之前没有研究将HM喂养与改善婴儿健康状况和降低新生儿重症监护病房（NICU）护理成本结结性地联系起来，也没有研究解决更长时间和/或关键时期暴露于HM喂养对于实现这些有益结果是否必要。在缺乏这一证据的情况下，提供母乳喂养的费用（大部分由母亲而不是公共和私人保险公司承担）成为VLBW婴儿母亲开始和维持哺乳的障碍，这些婴儿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研究高体重婴儿在新生儿重症监护病房（NICU）期间使用高体重婴儿喂养的剂量和暴露时间自变量与婴儿健康结局和成本节约的因变量之间的关系。该项目将对600名来自不同种族和经济背景的母亲（40%的非裔美国人，40%的非西班牙裔白人，20%的西班牙裔，60%的低收入）在新生儿重症监护室期间出生的VLBW婴儿进行前瞻性队列研究，以验证3个主要假设：高剂量和更长时间和/或关键时期暴露于HM喂养与1)较低的相对死亡率和早产儿发病率相关；2)新生儿重症监护病房住院时间较短，婴幼儿发育适宜；3)降低新生儿重症监护病房总费用。同意参加本研究的符合条件的婴儿及其母亲将在婴儿入住新生儿重症监护病房时登记。处理HM喂养的剂量和暴露时间的自变量的数据将在婴儿整个新生儿重症监护室住院期间的每次肠内喂养中以电子方式收集。处理婴儿健康结果和成本的因变量的数据将定期以电子方式收集，并将包括提供母乳喂养的短期成本，如吸奶器租金、母乳喂养储存容器的数量、获得哺乳专家的机会，以及新生儿重症监护病房的医疗保健总成本。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。意义：本研究首次对非裔美国人和低收入妇女所生的VLBW婴儿进行了前瞻性研究，探讨了HM喂养的剂量和暴露期与婴儿健康结局和HM喂养成本之间的关系。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新生儿重症监护病房协议。项目的叙述

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.