The Value of Liquid Gold

NICU

Jan 24

Written By

Prematurity on the Rise

A recent report from the March of Dimes confirms the rate of preterm birth is on the rise: now up to 9.8% in 2016 from a rate of 9.6% the previous year. Very-low birthweight infants (VLBWs - infants born < 1500g or 3 pounds 4.9 ounces) are the most expensive patients for a hospital, averaging $76,224 in direct costs to the unit. Another source put the larger societal burden of preterm birth at $928,800 per infant through age 18 years old.

Consequently - as more premature infants enter neonatal intensive care, the overall costs related to preterm birth increase. Preventing and reducing preterm birth is truly a public health priority.

Why Breastmilk Matters

Breastmilk is a complex mix of bioactive, cellular, and nutritional components that work together to protect and grow vulnerable infants in the NICU. Years of empirical research demonstrates incontrovertible proof that premature infants who receive maternal breastmilk develop less infections, have shorter hospital stays, and better long-term outcomes.

A recent study by National Health Service (NHS) in the United Kingdom analyzed 51,700 preterm births in 2013 and estimated £46.7 million worth of savings with 238 fewer deaths if 100% of those premature infants received maternal breastmilk.

In 2015, the CDC reported 382,800 preterm births in the US.

Adjusting for current exchange rate, the NHS study translates to a total lifetime cost-savings of $450 million and 1,762 fewer deaths in the US, if all premature babies were to receive 100% maternal breastmilk.

Why Should Hospitals Care

Breastmilk reduces the incidence and/or severity of certain illnesses related to prematurity. Researchers are now focusing on the specific cost-savings that can be applied to an individual hospital by increasing their breastfeeding rates.

There are 4 specific illnesses associated with the highest rates of health complications and costs for premature infants.

1. Necrotizing Enterocolitis (NEC) - NEC is a serious intestinal infection and just one case of medical NEC can cost a hospital up to $76,700 with surgical interventions costing as high as $205,300. One of the greatest proven interventions to prevent NEC is a human milk diet.

When feeding an exclusive human milk diet, recent research shows NEC rates dropping to as low as 1.1% compared with a rate of 11% with formula feeds.

2. Bronchopulmonary Dysplasia (BPD) - BPD is a serious lung disease that can lead to difficulty in breathing and issues with lung function and can cost up to $41,900 per infant to a hospital. A recent study found a dose-response relationship between the amount of exclusive breastmilk received by an infant and their risk for BPD. For every additional 10% increase in the volume of breastmilk received by the infant, their risk for BPD dropped by 9.5%.

3. Late-Onset Sepsis - Late onset sepsis, a total body blood infection, occurs in as many as 22% of VLBW infants at an increased cost of $11,100 to the hospital per episode.

Patel, et al quantified that breastmilk could save as much as $32,000 per infant in direct hospital costs by reducing late-onset sepsis on the unit.

4. Retinopathy of Prematurity (ROP) - ROP is an eye disease that involves the abnormal growth of blood vessels near the retina of the eye. In severe cases, these blood vessels can cause retinal detachment and serious vision problems, even blindness. In the case of Stage IV ROP (partial retinal detachment), additional hospital costs could be as high as $41,200 per infant. One study demonstrated that exclusive human milk feeds are associated with a 75% lower chance of developing Stage II or Stage III ROP in VLBW infants.

Cost of Donor Milk

Jeiger, et al found that, for every 100mL, a hospital spends on average $15.47 for donor milk, $3.28 for preterm formula, and ~$1.25 for maternal breastmilk (storage containers, pumping accessories, etc.). VLBW babies are roughly fed 6.5L through their entire hospital stay.

If you apply Jeiger, et al’s findings, that would total the minimum hospitalization costs per infant to $1005 to DHM, $213 for preterm formula, and $81.25 for maternal breastmilk storage and handling.

How Keriton Helps

When we started product development for Keriton in 2016, we realized 2 things -

The current market offerings were failing our nurses. Legacy breastmilk scanning systems do a poor job of automating quality and performance improvement, so nurses were spending too much time on “bartending” milk.
None of the legacy systems helped achieve goals of family-centered care or helped moms improve their breastmilk supply.

Keriton resolved to fix both the problems with a 2-part system - a mobile app for the moms and a mobile/desktop app for the nurses -

Smart features like automatic expiration management, and simple scan-to-receive new bottles from parents, save critical nurse time in the process.
Optimized milk management means less donor milk and formula feeds to buy.
By introducing an automated workflow, we eliminated a need for 2-RN checks and ensured that each and every step in preparing and feeding was validated and audited.
With real-time lactation analytics, we enable lactation consultants to proactively intervene to help moms establish their milk supply.
Integrated HIPAA-compliant chat and photo-sharing tools help the NICU deliver on family-centered care goals, and provides lactating mothers the stimuli to help them establish their breastmilk supply.

Keriton is the world’s first company collecting large scale lactation data and has shown amazing results in live deployments -

50% reduction in milk expiration
2x faster than other milk management/barcoding systems
Up to 100% increase in a mom’s average pumping output
Identified and solved several unit-wide practice flaws and critical errors

Based on our observations and calculations from peer-reviewed research published in AAP, NCBI, etc, we’ve found a direct P&L impact (nursing time saved, labels saved, etc.) of $0.5M - $1M and an indirect P&L impact (due to improved breastmilk outcomes, improved safety) of $3M - $5M.

Focusing on ways to increase maternal breastmilk clearly demonstrates cost savings for hospital units. An investment in a holistic feeding management platform is well worth it! Contact us to learn how Keriton can help optimize milk management at your NICU.

[su_accordion class=""][su_spoiler title="References" open="no" style="default" icon="plus" anchor="" class=""]March of Dimes. (2017, Nov 8). Premature Birth Report Card. Retrieved from https://www.marchofdimes.org/mission/prematurity-reportcard.aspxJohnson, T.J., Patel, A.L., Bigger, H.R., Engstrom, J.L., & Meier, P.P (2014). Economic benefits and costs of human milk feedings: a strategy to reduce the risk of prematurity-related morbidities in very-low-birth-weight infants. Advances in Nutrition, 5, 207-212.Behrman, R.E. & Butler, A.S. (2009). Preterm Birth: Causes, Consequences, and Prevention. Washington, DC: National Academies Press.Mahon, J., Claxton, L, & Wood, H., (2016). Modelling the cost-effectiveness of human milk and breastfeeding in preterm infants in the United Kingdom. Health Economics Review, 6(1), 54.Johnson, T.J., Patel, A.L., Bigger, H.R., Engstrom, J.L, & Meier, P.P. (2015). Cost savings of human milk as a strategy to reduce the incidence of necrotizing enterocolitis in very low birth weight infants. Neonatology: Fetal and Neonatal Research, 107(4), 271-276.Hair, A.B., Peluso, A.M., Hawthorne, K.M., Perez, J., Smith, D.P., Khan, J.Y., O’Donnell, A., Powers, R.J., Lee, M.L., & Abrams, S.A. (2016). Beyond necrotizing enterocolitis prevention: improving outcomes with an exclusive human milk-based diet. Breastfeeding Medicine, 11(2), 70-74.Johnson, T.J., Patel, A.L., Bigger, H.R., Engstrom, J.L., & Meier, P.P (2014). Economic benefits and costs of human milk feedings: a strategy to reduce the risk of prematurity-related morbidities in very-low-birth-weight infants. Advances in Nutrition, 5, 207-212.Patel, A.L., Johnson, T.J., Engstrom, J.L., Fogg, L.F., Jegier, B.J., Bigger, H.R., & Meier, P.P. (2013). Impact of early human milk on sepsis and health care costs in very low birth weight infants. Journal of Perinatology, 33(7), 514-519.Johnson, et al. (2014). Advances in Nutrition, 5, 207-212.Patel, A.L., Johnson, T.J., Robin, B., Bigger, H.R., Buchanan, A.; Chrisitan, E., Nandhan, V., Shroff, A., Schoeny, M., Engstrom, & J.L., Meier, P.P. (2017). Influence of own mother’s milk on bronchopulmonary dysplasia and costs. Archives of Disease in Childhood: Fetal and Neonatal Edition, 102(3), F256-F261.Black, L., Hulsey, T., Lee, K., Parks, D.C., & Ebling, M.D. (2015). Incremental hospital costs associated with comorbidities of prematurity. Managed Care, 24(12), 54-60.Lenhartova, N., Matasova, K., Lasabova, Z., Javorka, K., & Calkovska, A. (2017). Impact of early aggressive nutrition on retinal development in premature infants. Physiological Research, 22(6-Supplementum 2), S215-S226.Ginovart, G., Gich, I., & Verd, S. (2016). Human milk feeding protects very low-birth-weight infants from retinopathy of prematurity: a pre-post cohort analysis. The Journal of Maternal-Fetal and Neonatal Medicine, 29(23), 3790-3795.Jeiger, B.J., Johnson, T.J., Engstrom, J.L., Patel, A.L., Loera, F., & Meier, P.P. (2013). The institutional cost of acquiring 100mL of human milk for very low birth weight infants in the neonatal intensive care unit. Journal of Human Lactation, 29(3), 390-399.Colaizy, T.T., Bartick, M.C., Jegier, B.J., Green, B.D., Reinhold, A.G., Schaefer, A.J., Bogen, D.L., Schwartz, E.B., & Stuebe, A.M. (2016). Impact of optimized breastfeeding on the costs of necrotizing enterocolitis in extremely low birthweight infants. Journal of Pediatrics, 175, 101-105.Assad, M., Elliot, M.J., & Abraham, J.H. (2016). Decreased cost and improved feeding intolerance in VLBW infants fed an exclusive human milk diet. Journal of Perinatology, 36(3), 216-220.Petrou, S., Eddama, O., & Mangham, L. (2011). A structured review of the recent literature on the economic consequences of preterm birth. Archives of Disease in Childhood: Fetal and Neonatal Edition, 96, F225-F232.[/su_spoiler][/su_accordion]