FEBRUARY 2011

Greetings from the Prolacta Team

LATCH… "to acquire understanding of, to comprehend"

Prolacta Bioscience's eNewsletter serves to extend our mission of "making a meaningful difference in the lives of thousands of the most vulnerable infants through world class research and innovative products" by providing the health care professional with a brief overview of evolving research, current clinical issues and emerging strategies relevant to the care of the premature infant and sick newborn.

In this edition we will examine the considerable, and often hidden, costs of prematurity, safety issues associated with the practice of non-screened human milk sharing and quality improvement strategies regarding the use of human milk in the NICU. We hope you find them helpful.

The Cost of Prematurity

In addition to the considerable physical and emotional costs associated with preterm birth, the financial costs of prematurity are staggering. According to an analysis by the March of Dimes in 2007, the average medical cost for healthy full-term babies from birth through their first birthday was $4,551 in 2007, of which more than $3,800 is paid for by health plans. For premature and/or low birth weight babies (less than 37 completed weeks gestation and/or less than 2500 grams), the average cost was nearly $50,000, of which more than $46,000 was borne by the health plan.

These costs, in 2005 dollars, are summarized below:

• The annual societal economic cost (medical, educational and lost productivity) associated with preterm birth in the U.S. was at least $26.2 billion or $51,600 per infant born preterm
• Of this total, medical care services contributed $16.9 billion
• Maternal delivery costs contributed another $1.9 billion
• Early intervention services cost an estimated $611 million
• Special education services associated with the higher prevalence of four major disabling conditions among preterm infants (cerebral palsy, mental retardation, vision impairment and hearing loss) added another $1.1 billion
• Lost household and labor market productivity associated with preterm birth disabilities contributed $5.7 billion

An article entitled “Million Dollar Babies”, that first appeared on the Bloomberg Businessweek website in June 2008 , describes the impact of prematurity on corporate America secondary to the combination of increased health care costs for the infant and loss of work productivity by the parents.
http://www.businessweek.com/magazine/content/08_25/b4089046084131.htm

The March of Dimes has also developed a tool to help address the financial cost of prematurity for employers and employees. "Healthy Babies, Healthy Business" is a multi-dimensional health education program for the workplace offers resources to help companies improve both employee health and the health of the company's bottom line. A video presentation by Dr. Jennifer Howse, President of the March of Dimes, discussing this model can be seen at http://www.marchofdimes.com/hbhb/

The FDA Weighs In on Milk Sharing

On December 6 2010, the Food and Drug Administration's Pediatric Advisory Committee (PAC) met to discuss current practices in human milk donation, banking and distribution. The FDA does not regulate human milk banking, but recognizes that there are inherent risks associated it. A current safety concern involves the growing practice of informal milk sharing between mothers, without the benefit of safety screening of either the donor or the milk itself. While rooted in altruism, and fostered by the growing number of social media tools, there is a potential risk involved.

The purpose of the meeting was to, "explore potential risks of exposure to human breast milk obtained from sources other than an infant's own mother, with particular focus on risks associated with transmission of viral infections, chemical contamination and bacterial contamination"¹. The meeting brought together professional experts from industry, academia and regulatory bodies to discuss current practices of human milk banking and human milk processing, as well as the regulatory approaches taken at the state level.

Prolacta is proud to have been asked to participate in such an important discussion. The full meeting materials, including the presentations and flash minutes, can be found at:

Click Here to View

¹http://www.fda.gov/downloads/AdvisoryCommittees/CommitteesMeetingMaterials/PediatricAdvisoryCommittee/
UCM238627.pdf

Improving the Use of Human Milk in the NICU

A recent article published in the Clinics in Perinatology describes quality improvement initiatives focused on the use of human milk in the NICU. The article represents the clinical experience from the Rush Department of Women, Children and Family Nursing and Rush University Medical Center NICU in Chicago. The authors point out that quality improvement initiatives that focus "only on increasing the percentage of NICU infants that are "human milk fed" will be inadequate if specific amounts and time periods of human milk feeding are not specified".

The article develops the concept of "dose and exposure periods" for human milk feeding in the NICU that include: (1) Colostrum as the transition from intrauterine to extrauterine nutrition; (2) Transition from colostrum to mature milk feedings during the first month post birth; (3) Human milk feedings throughout the NICU stay; and (4) Human milk feedings after NICU discharge.

The authors also provide numerous examples of "best practices" to increase the dose and exposure period of human milk feedings. These include the use of language when that refers to human milk as a "medicine" that only the mother can provide in conversations when encouraging the mother to provide milk for her infant; providing cost-effective, expert lactation support using both professional and peer counselors, and prioritizing the initiation, establishment and maintenance of maternal milk volume.

The entire article is available at Clin Perinatol 37 (2010) 217-245 doi:10.1016/j.clp.2010.01.013.