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Economic barriers to the initiation and maintenance of lactation: Estimated average cost of required services per infant | LATCH

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Author: Terry S. Johnson, APN, NNP-BC, ASPPS, CLEC, MN

The initiation, maintenance, and successful feeding of a mother’s own milk (MOM) to the extremely low birth weight infant in the NICU is a formidable task. All members of the health care team, regardless of their professional discipline have a role to play in the success of this nutritional endeavor. In a review by Meier, et al., (2017) methods to promote human milk feeding of preterm infants were identified and described.

The authors note that “many of the evidence-based interventions to maintain lactation in this population such as timely access to effective and efficient breast pumps, freezer storage space, and proactive NICU-specific lactation care, have not been adopted due to the upstart economic investments that would be required” (Meier, et al, 2017). The authors then document the cost-barriers for initiation and maintenance of lactation in their own unit, Rush University Medical Center.

Barrier

Cost per Infant

Low

High

Assumptions

1 Provision of professionally produced, evidence-based materials targeting the importance of human milk (HM) for preterm infants + monitoring of HM volume and goals for HM feeding Brochure + education sheets = $10Mother's Milk Volumes (MMV) record = $5.50Maternal Goals record = $0.10 $15.60 $15.60 1 set of materials per infant 2 Hospital-grade electric breast pump rental for 3 mo (through term-corrected age) $40 to $70 per month $120.00 $210.00 3 mo rental; low estimate assumes $40 per month, wholesale cost; high estimate assumes $70/mo retail cost 3 Provision of pump kit $32.91 cost per kit $32.91 $32.91 1 kit per infant 4 Access to custom-fitted breast shields for effective, efficient and comfortable HM removal $7 retail cost $7.00 $7.00 1 set per infant 5 Provision of sufficient numbers of hospital-grade HM storage containers for pumped HM $0.21 cost per container $89.46 134.19 Low estimate assumes 6 containers/d (350 mL/120 × 1.2 rounded to next multiple of 3); high estimate assumes 9 containers/d (700 mL/120 × 1.2 rounded to next multiple of 3); for 71-d NICU stay 6 Access to NICU-specific lactation support from NICU-based certified breastfeeding peer counselors (BPCs) during coming to volume, weekly group forums, and on an individual basis, as needed $18/h + 26% fringe benefits $417.11 $539.79 71-d NICU stay; $18/h + 26% fringe benefits; low estimate assumes 2 BPCs for 44 infants per day; high estimate assumes 2 BPC for 33 infants per day 7 Availability of NICU freezers for safe storage of all pumped HM (eg, not telling mothers to store HM in the home and bring it in as needed) $8000 cost per freezer $6.92 $10.37 Storage for 15 infants per freezer; low estimate assumes 15 y life; high estimate assumes 10 y life; for 71 d length of NICU stay 8 Use of HM waterless warmers to avoid HM contamination with waterborne pathogens $773 cost per warmer $30.07 $50.12 1 warmer per infant for 71 d NICU stay; low estimate assumes 5 y life; high estimate assumes 3 y life 9 Use of liners for waterless warmer $3.25 cost per liner $230.75 $230.75 1 liner/d for 71 d NICU stay 10 Basic creamatocrit and/or other HM analysis technology to individualize HM feedings and HM collection strategies $1500 per creamatocrit $0.38 $0.63 1 creamatocrit per NICU; assumes 800 NICU admissions per year; low estimate assumes 5 y life; high estimate assumes 3 y life 11 Availability of infant scales for measuring HM intake during breastfeeding $1500 per scale $3.89 $6.48 1 scale per 15 infants for NICU stay; low estimate assumes 5 y life; high estimate assumes 3 y life Total $954.08 $1237.84

Costs reported in U.S. dollars. Based on Average length of NICU stay for VLBW infants of 71 days from RUMC data. The low and high cost figures of $954.08 and $1237.84 respectively to initiate and maintain lactation are striking considering some published financial data on costs in the NICU patient population. Consider the estimated annual average hospitalization cost per infant of $201,250 from the incremental costs associated with prematurity-related morbidities and interventions such as necrotizing enterocolitis (NEC), bronchopulmonary dysplasia (BPD), retinopathy of prematurity (ROP) requiring surgery, late-onset sepsis (LOS) total parenteral nutrition (TPN) 2,3 A second figure to consider when assessing the cost benefit of providing lactation support in the NICU i reported by Cacho, et al., 2017) is that “Each additional milliliter per kilogram per day of MOM an infant receives during the first 28 days of life reduces hospital costs by $534.00.”4 Maybe it’s time to DO THE MATH.

Reference

Meier, PP, et. al. Evidence-Based Methods That Promote Human Milk Feeding of Preterm Infants. Clinics in Perinatology, Volume 44 , Issue 1 , 1 – 22. DOI: 10.1016/j.clp.2016.11.005