Impact of early human milk on sepsis and health-care costs in very low birth weight infants

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OBJECTIVE:To study the incidence of sepsis and neonatal intensive care unit (NICU) costs as a function of the human milk (HM) dose received during the first 28 days post birth for very low birth weight (VLBW) infants.STUDY DESIGN:Prospective cohort study of 175 VLBW infants. The average daily dose of HM (ADDHM) was calculated from daily nutritional data for the first 28 days post birth (ADDHM-Days 1–28). Other covariates associated with sepsis were used to create a propensity score, combining multiple risk factors into a single metric.RESULT:The mean gestational age and birth weight were 28.1 ±2.4 weeks and 1087±252 g, respectively. The mean ADDHM-Days 1–28 was 54±39ml kg-1 day-1 (range 0–135). Binary logistic regression analysis controlling for propensity score revealed that increasing ADDHM-Days 1–28 was associated with lower odds of sepsis (odds ratio 0.981, 95% confidence interval 0.967–0.995, P = 0.008). Increasing ADDHM-Days 1–28 was associated with significantly lower NICU costs.CONCLUSION:A dose-response relationship was demonstrated between ADDHM-Days 1–28 and a reduction in the odds of sepsis and associated NICU costs after controlling for propensity score. For every HM dose increase of 10 ml kg-1 day-1, the odds of sepsis decreased by 19%. NICU costs were lowest in the VLBW infants who received the highest ADDHM-Days 1–28.

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