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How Breastfeeding and Donor Milk Are More Cost-Effective Than Preterm Formula

— February 10, 2023

Premature infants face unique challenges to their health and well-being. One of the most important is necrotizing enterocolitis (NEC), a severe and potentially fatal digestive disorder that occurs in medically fragile preterm or low birth weight infants.

When it comes to the health and well-being of premature babies, all parents want to do what’s best for their children. But with health care costs so high, many families are questioning which solution is most cost-effective.

Premature infants face unique challenges to their health and well-being. One of the most important is necrotizing enterocolitis (NEC), a severe and potentially fatal digestive disorder that occurs in medically fragile preterm or low birth weight infants. The condition is caused by a breakdown of the intestinal lining that leads to inflammation and necrosis, requiring prolonged hospitalization and surgery.

NEC not only places a significant financial burden on families but can also lead to lifelong neurological and nutritional complications for the child. Therefore, health care professionals and parents must prioritize the prevention of NEC in preterm infants by providing adequate nutrition and monitoring the infant’s health.

The financial benefits of breastfeeding and donor milk for preterm infant health care

Studies from the 1990s, as well as a recent study published in Pediatrics and Child Health, have shown that preterm infants fed cow milk-based infant formula have a higher risk of developing NEC than those fed only breast milk. Research has also shown that premature infants who are exclusively breastfed have a lower risk of developing NEC than those who receive a combination of breast milk and formula.

In addition, breastfeeding can also save families money on infant formula and other feeding supplies. According to a study published in the American Dietetic Association, breastfeeding each infant enrolled in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) saved $478 in costs and Medicaid expenditures during the first six months of the infant’s life compared to formula feeding. 

Non-breastfeeding mothers spent an extra $46 a month in addition to WIC-provided infant formula during their child’s fourth month of life. For low-income families, these costs can be a significant financial burden. However, if mothers in WIC households increased their breastfeeding rates to the medically recommended level, the savings in health care costs would be about $9.1 billion.

A mother’s breast milk protects against NEC but is not always available. In such cases, donor milk has also been shown to be more protective, although to a lesser extent, than the mother’s breast milk. Using donated breast milk instead of cow milk-based infant formulas can significantly reduce the incidence of NEC, the need for parenteral nutrition, and the time required for complete enteral nutrition. Although donor milk is more expensive than breastfeeding, it can still result in significant financial savings for families.

Every dollar spent on pasteurized donor milk in the neonatal intensive care unit or health care setting translates into a cost savings of about $11 by avoiding longer hospital stays, NEC, and sepsis. A study from 2020 confirms that the use of mother’s milk and donor milk in the neonatal intensive care unit was associated with $15.555 lower costs per infant and saved $1.812 per percentage point decrease in NEC incidence.

In addition, the use of mother’s breast milk and donor milk is also cost-effective for the healthcare system, reducing the need for hospitalization and treatment. This is critical for the health care system because premature infants represent a large portion of health care expenditures.

About 20-40% of infants with NEC require surgery. Data from a Government nationwide study sample of inpatients show that the average length of hospital stay for an infant with NEC is 38.9 days, at an average cost of $50,000 per case. Thus, the economic benefits of increasing breastfeeding rates in the hospital can be substantial in reducing the number of infants with NEC and the associated costs.

The risks of cow milk-based infant formulas

Parents need to be cautious when choosing cow’s milk-based infant formulas, as some brands still available on the market have been linked to NEC in premature infants. Consequently, concerned parents and caregivers have taken it upon themselves to point out that it is scientifically proven that cow’s milk formula can cause NEC in premature infants and accuse certain manufacturers of ignoring the risks and failing to include warnings on product labels.

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Photo by Stijn te Strake on Unsplash

Some conclusions can be drawn from an examination of recent NEC-related litigation. Currently, 97 lawsuits allege that the manufacturers of Similac (Abbott Laboratories) and Enfamil (Mead Johnson) failed to warn that their potentially toxic cow’s milk-based infant formulas could cause premature infants to develop or die from NEC. Several lawsuits have also been filed against physicians who prescribed Similac and Enfamil, with families being compensated through settlements or court judgments.

The parents argue that Abbott Laboratories and Mead Johnson knew or should have known of the potential dangers of their toxic baby formula, particularly the presence of bovine spongiform encephalopathy (BSE) in cow’s milk and its link to NEC, and should have warned of these risks.

The manufacturers of Similac and Enfamil deny that their products cause NEC. They state that gastrointestinal disorders can occur naturally in premature infants fed breast milk and that claims of unsafe infant feeding products are not permitted under the Infant Formula Act.

Alternative infant formula for families who cannot breastfeed or use donor milk

Breastfeeding and using breast or donor milk remain the first choice for the health and well-being of premature infants. But when breastfeeding or using breast or donor milk is not possible, infant formulas can be used as an alternative. However, it is important to be aware of the potential risk of necrotizing enterocolitis in cow’s milk-based products.

Safe infant formulas are available for families who are not breastfeeding or rely on donor milk. These infant formulas are designed to mimic the composition of breast milk as closely as possible and effectively prevent NEC and can be recommended by health care professionals.

Families with preterm infants need to be informed about the risks and benefits of the different feeding options and make an informed decision. Breastfeeding and donor milk remain the best options to prevent NEC and other digestive problems. The cost-effectiveness and medical benefits of breastfeeding and donor milk for preterm infants are pretty straightforward: the incidence of NEC is 6- to 10-fold lower in breastfed or donor milk-fed infants, and these infant feeding practices can save health care costs. 

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