Hospital Financial Assessment
Annual Cost of NEC
Total NEC Cost vs. # of Annual Cases
$8,000,000
$7,000,000
Patient Population 400
Patient Population 500
Patient Population 600
Incurred Hospital Cost ($$)
$6,000,000
Mortality Rates for NEC
Range from 20-40% of
All cases
$5,000,000
$4,000,000
$3,000,000
$2,000,000
$1,000,000
$0
1
2
3
5
7
10
NEC Rate - Percentage of total population
Reference: Pediatrics 2002;109,423-428;Impact of Necrotizing Enterocolitis on Length of Stay and Hospital Charges in Very Low Birth Weight Infants
-Chart based on taking 40% of the NEC population requiring surgery and 60% having Medical NEC
-VON reports that 12% of patient population under 27 weeks develop NEC and 2% over the entire NICU population
Increased Breastmilk Usage Translating into
Savings
•
•
•
•
Exclusively formula fed babies are 6-7 more times likely to develop NEC than exclusively breastmilk fed babies and 3
times more likely than those receiving both. (Graph assumes a 7x increase)
Chart Based on VON data of ~50% as a baseline of Population receiving some breastmilk by discharge
Baseline NEC rates are on the bottom and are represented with the 50% BF rate. By increasing the BF rates, the NEC
percentages decrease
Based Hospital Admission of 500 annually
6,000,000
Hospital Incurred Cost ($$)
5,000,000
4,000,000
50% BF Rate Baseline
60% BF Scenario
70% BF Scenario
80% BF Scenario
90% BF Scenario
100% BF Scenario
3,000,000
2,000,000
1,000,000
0
Baseline 1%NEC
Baseline 3%NEC
Baseline 5%NEC
Baseline 7%NEC
Baseline 10%NEC
NEC
• Medical NEC
–
–
–
–
exhibits signs/symptoms without perforation
Adds 22 additional days to LOS
Increases death by 14%
Overall hospital charges $300,000
$73K in incremental hospital charges
• Surgical NEC
–
–
–
–
radiographic evidence of perforated bowel
Adds 60 additional days to LOS
Increases death by 24.5%
Overall hospital charges $450,000
$190K in incremental hospital charges
Additional Benefits of Breastmilk in the NICU
Outcome
Fortified
HM
Preterm
Formula
19+21
33+41
1(1.6%)
6(13%)
0
3
Late-Onset Sepsis
n, (%)
19(31%)
22(48%)
Late-Onset Sepsis
# of episodes/patient
0.3+0.5
0.6+0.7
Positive Blood
Cultures (#/infant)
0.5+0.9
1.2+1.7
NEC or Sepsis, n (%)
19(31%)
25(54%)
16%
39%
O2 Therapy (days)
NEC (n)
Surgical NEC (n)
GERD Medications
(%)
Schanler et al., Pediatrics 103, 1999;1150-1157
For every 10-ml/kg per day increase in
Breastmilk ingestion:
• The Mental Development Index Increased
by 0.53 points
• The Psychomotor Development Index
increased by 0.63 points
• Behavior Rating Scale Percentile Score
increased by 0.82 points
• Likelihood of rehospitalization decreased
by 6%
Vohr et al., Beneficial effects of breastmilk in the neonatal intensive care unit on
the developmental outcome of extremely low birthweight infants at 18 months of age;
Pediatrics 2006;118;e115-e123
Impact of a Strong Lactation Program for Neonates
2 Year Study Performed at Children’s Hospital of the King’s Daughters in Norfolk, VA
• Usual Support encompassed
period between 1996-1998
when no lactation support
was available
• IBCLC Support encompassed
2 full time IBCLC’s with RN
backgrounds and a 3rd in
training
Gonzalez et al.,Journal of Human Lactation 2003:19:286
Cost Benefit of a NICU Lactation Program
Lactation FTE’s –
Assume $100,000 (Salary + Benefits)
Assume RN with IBCLC
Assume 2 FTE = $200,000
Pumps
No Charge
Kits
Based on 500 Annual Admissions
80% Breastfeeding Rate
Total Kits Consumed 400 + 20% contingency for replacements
Total Kits Consumed 480
$13,000 Annually
Containers
Assume Annual Usage of 140,000 units
Annual Cost = $35,000
Total Cost:
$257,000 annually
References