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Yoo S, Dhingra M, Gaughan J, Daneshpooy S, Bhana NB, Bartick MC, Feldman-Winter L. Challenges and Opportunities of Using a National Database to Evaluate Racial/Ethnic Disparities and Breastfeeding Effects on Sudden Unexpected Infant Death. Breastfeed Med 2022; 17:964-969. [PMID: 36257616 DOI: 10.1089/bfm.2022.0097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Background: Sudden unexpected infant death (SUID) rates remain higher in American Indian/Alaska Native (AI/AN) and non-Hispanic Black (NHB) infants than other demographic groups. Racial disparities are also evident in breastfeeding, which is associated with reduced risk of SUID. Objective: To assess the relationship between racial/ethnic disparities in SUID and breastfeeding beyond the newborn period using U.S. nationally reported public databases. Methods: Data were extracted from Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research (WONDER) and the National Immunization Surveys (NISs) 2009-2017. WONDER data were restricted to full-term infants and sorted by death year, race/ethnicity, and other characteristics. NIS breastfeeding data included ever breastfed, breastfed at 6 months, and exclusive breastfeeding at 3 and 6 months. Breastfeeding rates and mortality data were aggregated based on race/ethnicity, and mortality rates were analyzed by weighted (number of births) multivariable linear regression. Results: SUID rates were highest among NHB and AI/AN infants who also had the lowest breastfeeding rates. When breastfeeding and race/ethnicity were included in the analyses, race/ethnicity confounded the relationship between breastfeeding and SUID. When race was excluded, ever breastfeeding and any breastfeeding at 6 months were associated with significantly decreased SUID rates. Conclusion: Race/ethnicity confounded the relationship between breastfeeding and SUID. Analysis was limited because individual SUID rates were available for maternal/birth characteristics but not for breastfeeding. Our study showed a need for adding additional data points to other national databases to better understand the role that breastfeeding plays in the racial/ethnic disparities in SUID.
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Affiliation(s)
- Sera Yoo
- Cooper Medical School of Rowan University, Camden, New Jersey, USA
| | - Menaka Dhingra
- Department of Internal Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - John Gaughan
- Department of Medicine, Cooper University Hospital, Camden, New Jersey, USA
| | - Saba Daneshpooy
- Cooper Medical School of Rowan University, Camden, New Jersey, USA
| | - Nikhil B Bhana
- Cooper Medical School of Rowan University, Camden, New Jersey, USA
| | - Melissa C Bartick
- Department of Medicine, Mount Auburn Hospital/Beth Israel Lahey Health, Cambridge, Massachusetts, USA.,Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Lori Feldman-Winter
- Department of Pediatrics, Children's Regional Hospital at Cooper University Healthcare-Cooper Medical School of Rowan University, Camden, New Jersey, USA
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2
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Gribble KD, Bewley S, Bartick MC, Mathisen R, Walker S, Gamble J, Bergman NJ, Gupta A, Hocking JJ, Dahlen HG. Effective Communication About Pregnancy, Birth, Lactation, Breastfeeding and Newborn Care: The Importance of Sexed Language. Front Glob Womens Health 2022; 3:818856. [PMID: 35224545 PMCID: PMC8864964 DOI: 10.3389/fgwh.2022.818856] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 01/10/2022] [Indexed: 01/12/2023] Open
Affiliation(s)
- Karleen D. Gribble
- School of Nursing and Midwifery, Western Sydney University, Parramatta, NSW, Australia
- *Correspondence: Karleen D. Gribble
| | - Susan Bewley
- Department of Women and Children's Health, King's College London, London, United Kingdom
| | - Melissa C. Bartick
- Mount Auburn Hospital, Cambridge, MA, United States
- Department of Medicine, Harvard Medical School, Boston, MA, United States
| | - Roger Mathisen
- Alive & Thrive Southeast Asia, FHI Solutions, Hanoi, Vietnam
| | - Shawn Walker
- Department of Women and Children's Health, King's College London, London, United Kingdom
- Chelsea and Westminster Hospital National Health Service (NHS) Foundation Trust, London, United Kingdom
| | - Jenny Gamble
- School of Nursing and Midwifery, Griffith University, Brisbane, QLD, Australia
- Centre for Health Care Research, Coventry University, Coventry, United Kingdom
| | - Nils J. Bergman
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Arun Gupta
- Breastfeeding Promotion Network of India, New Delhi, India
| | - Jennifer J. Hocking
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Melbourne, VIC, Australia
| | - Hannah G. Dahlen
- School of Nursing and Midwifery, Western Sydney University, Parramatta, NSW, Australia
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3
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Bartick MC, Valdés V, Giusti A, Chapin EM, Bhana NB, Hernández-Aguilar MT, Duarte ED, Jenkins L, Gaughan J, Feldman-Winter L. Maternal and Infant Outcomes Associated with Maternity Practices Related to COVID-19: The COVID Mothers Study. Breastfeed Med 2021; 16:189-199. [PMID: 33565900 DOI: 10.1089/bfm.2020.0353] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Background: Maternity care practices such as skin-to-skin care, rooming-in, and direct breastfeeding are recommended, but it is unclear if these practices increase the risk of clinically significant COVID-19 in newborns, and if disruption of these practices adversely affects breastfeeding. Methods: We performed a retrospective cohort study of 357 mothers and their infants <12 months who had confirmed or suspected COVID-19. Subjects came from an anonymous worldwide online survey between May 4 and September 30, 2020, who were recruited through social media, support groups, and health care providers. Using multivariable logistic regression, Fisher's exact test, and summary statistics, we assessed the association of skin-to-skin care, feeding, and rooming-in with SARS-CoV-2 outcomes, breastfeeding outcomes, and maternal distress. Results: Responses came from 31 countries. Among SARS-CoV-2+ mothers whose infection was ≤3 days of birth, 7.4% of their infants tested positive. We found a nonsignificant decrease in risk of hospitalization among neonates who roomed-in, directly breastfed, or experienced uninterrupted skin-to-skin care (p > 0.2 for each). Infants who did not directly breastfeed, experience skin-to-skin care, or who did not room-in within arms' reach, were significantly less likely to be exclusively breastfed in the first 3 months, adjusting for maternal symptoms (p ≤ 0.02 for each). Nearly 60% of mothers who experienced separation reported feeling "very distressed," and 29% who tried to breastfeed were unable. Presence of maternal symptoms predicted infant transmission or symptoms (adjusted odds ratio = 4.50, 95% confidence interval = 1.52-13.26, p = 0.006). Conclusion: Disruption of evidence-based quality standards of maternity care is associated with harm and may be unnecessary.
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Affiliation(s)
- Melissa C Bartick
- Department of Medicine, Mount Auburn Hospital, Cambridge, Massachusetts, USA.,Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Verónica Valdés
- Department of Family Medicine, School of Medicine, Catholic University, Santiago, Chile.,Lactation Committee, Chilean Pediatric Society, Santiago, Chile
| | - Angela Giusti
- National Centre for Disease Prevention and Health Promotion, Istituto Superiore di Sanità (National Institute of Health), Rome, Italy
| | - Elise M Chapin
- Baby-Friendly Initiatives, Italian National Committee for UNICEF, Rome, Italy
| | - Nikhil B Bhana
- Cooper Medical School, Rowan University, Camden, New Jersey, USA
| | | | - Elysângela Dittz Duarte
- Department of Maternal and Child Public Health, School of Nursing, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | | | - John Gaughan
- Department of Medicine, Cooper University Hospital, Camden, New Jersey, USA
| | - Lori Feldman-Winter
- Department of Pediatrics, Children's Regional Hospital, Cooper University Health Care-Cooper Medical School of Rowan University, Camden, New Jersey, USA
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4
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Blair PS, Ball HL, McKenna JJ, Feldman-Winter L, Marinelli KA, Bartick MC, Noble L, Calhoun S, Elliott-Rudder M, Kair LR, Lappin S, Larson I, Lawrence RA, Lefort Y, Marshall N, Mitchell K, Murak C, Myers E, Reece-Stremtan S, Rosen-Carole C, Rothenberg S, Schmidt T, Seo T, Sriraman N, Stehel EK, Wight N, Wonodi A. Bedsharing and Breastfeeding: The Academy of Breastfeeding Medicine Protocol #6, Revision 2019. Breastfeed Med 2020; 15:5-16. [PMID: 31898916 DOI: 10.1089/bfm.2019.29144.psb] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
A central goal of the Academy of Breastfeeding Medicine is the development of clinical protocols for managing common medical problems that may impact breastfeeding success. These protocols serve only as guidelines for the care of breastfeeding mothers and infants and do not delineate an exclusive course of treatment or serve as standards of medical care. Variations in treatment may be appropriate according to the needs of an individual patient.
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Affiliation(s)
- Peter S Blair
- Centre for Academic Child Health, University of Bristol, Bristol, United Kingdom
| | - Helen L Ball
- Infancy and Sleep Centre, Department of Anthropology, Durham University, Durham, United Kingdom
| | - James J McKenna
- Department of Anthropology, Santa Clara University, Santa Clara, California.,Mother-Baby Sleep Lab, Department of Anthropology, University of Notre Dame, South Bend, Indiana
| | - Lori Feldman-Winter
- Department of Pediatrics, Division of Adolescent Medicine, Cooper Medical School of Rowan University, Camden, New Jersey
| | - Kathleen A Marinelli
- Department of Pediatrics, University of Connecticut School of Medicine, Farmington, Connecticut.,Connecticut Children's Medical Center, Division of Neonatology, Hartford, Connecticut
| | - Melissa C Bartick
- Department of Medicine, Cambridge Health Alliance and Harvard Medical School, Cambridge Massachusetts
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5
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Bartick MC. Breastfeeding and Infant Mortality in the United States: A Tennessee Snapshot Is a Call to Action. Breastfeed Med 2019; 14:435-436. [PMID: 31287710 DOI: 10.1089/bfm.2019.0136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Melissa C Bartick
- Department of Medicine, Cambridge Health Alliance and Harvard Medical School, Cambridge, Massachusetts
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6
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Bartick MC, Hernández-Aguilar MT. Re: "A Critical Review of the Baby-Friendly Hospital Initiative Is in the Works" by Eidelman (Breastfeed Med 2018;13(9):557-558). Breastfeed Med 2019; 14:2-3. [PMID: 30620214 DOI: 10.1089/bfm.2018.0230] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Melissa C Bartick
- 1 Cambridge Health Alliance, Department of Medicine, Cambridge, Massachusetts.,2 Harvard Medical School, Boston Massachusetts
| | - Maria-Teresa Hernández-Aguilar
- 3 Breastfeeding Clinical Unit, University Hospital Dr. Peset, National Health Service, Valencia, Spain.,4 National Coordination of Spain Baby-Friendly Initiative (IHAN-España Iniciativa para Humanización de la Asisistenciancia al Nacimiento y Lactancia), Madrid, Spain
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7
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Stuebe AM, Jegier BJ, Schwarz EB, Green BD, Reinhold AG, Colaizy TT, Bogen DL, Schaefer AJ, Jegier JT, Green NS, Bartick MC. An Online Calculator to Estimate the Impact of Changes in Breastfeeding Rates on Population Health and Costs. Breastfeed Med 2017; 12:645-658. [PMID: 28906133 DOI: 10.1089/bfm.2017.0083] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE We sought to determine the impact of changes in breastfeeding rates on population health. MATERIALS AND METHODS We used a Monte Carlo simulation model to estimate the population-level changes in disease burden associated with marginal changes in rates of any breastfeeding at each month from birth to 12 months of life, and in rates of exclusive breastfeeding from birth to 6 months of life. We used these marginal estimates to construct an interactive online calculator (available at www.usbreastfeeding.org/saving-calc ). The Institutional Review Board of the Cambridge Health Alliance exempted the study. RESULTS Using our interactive online calculator, we found that a 5% point increase in breastfeeding rates was associated with statistically significant differences in child infectious morbidity for the U.S. population, including otitis media (101,952 cases, 95% confidence interval [CI] 77,929-131,894 cases) and gastrointestinal infection (236,073 cases, 95% CI 190,643-290,278 cases). Associated medical cost differences were $31,784,763 (95% CI $24,295,235-$41,119,548) for otitis media and $12,588,848 ($10,166,203-$15,479,352) for gastrointestinal infection. The state-level impact of attaining Healthy People 2020 goals varied by population size and current breastfeeding rates. CONCLUSION Modest increases in breastfeeding rates substantially impact healthcare costs in the first year of life.
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Affiliation(s)
- Alison M Stuebe
- 1 Department of Obstetrics and Gynecology, School of Medicine, University of North Carolina at Chapel Hill , Chapel Hill, North Carolina.,2 Carolina Global Breastfeeding Institute, Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill , Chapel Hill, North Carolina
| | - Briana J Jegier
- 3 Department of Health Services Administration, D'Youville College , Buffalo, New York
| | | | - Brittany D Green
- 5 Department of Operations Business Analytics and Information Systems, University of Cincinnati , Cincinnati, Ohio
| | - Arnold G Reinhold
- 6 Alliance for the Prudent Use of Antibiotics, Boston, Massachusetts
| | - Tarah T Colaizy
- 7 Department of Neonatology, Carver College of Medicine, University of Iowa , Iowa City, Iowa
| | - Debra L Bogen
- 8 Department of Pediatrics, University of Pittsburgh , Pittsburgh, Pennsylvania
| | - Andrew J Schaefer
- 9 Department of Computational and Applied Mathematics, Rice University , Houston, Texas
| | | | - Noah S Green
- 1 Department of Obstetrics and Gynecology, School of Medicine, University of North Carolina at Chapel Hill , Chapel Hill, North Carolina
| | - Melissa C Bartick
- 11 Department of Medicine, Cambridge Health Alliance , Cambridge, Massachusetts.,12 Department of Medicine, Harvard Medical School , Boston, Massachusetts
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8
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Affiliation(s)
- Melissa C Bartick
- Department of Medicine, Cambridge Health Alliance, Cambridge, Massachusetts
| | - Nathan C Nickel
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Canada
| | - Lauren E Hanley
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston
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9
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Bartick MC, Jegier BJ, Green BD, Schwarz EB, Reinhold AG, Stuebe AM. Disparities in Breastfeeding: Impact on Maternal and Child Health Outcomes and Costs. J Pediatr 2017; 181:49-55.e6. [PMID: 27837954 DOI: 10.1016/j.jpeds.2016.10.028] [Citation(s) in RCA: 103] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Revised: 09/20/2016] [Accepted: 10/07/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To estimate the disease burden and associated costs attributable to suboptimal breastfeeding rates among non-Hispanic blacks (NHBs), Hispanics, and non-Hispanic whites (NHWs). STUDY DESIGN Using current literature on associations between breastfeeding and health outcomes for 8 pediatric and 5 maternal diseases, we used Monte Carlo simulations to evaluate 2 hypothetical cohorts of US women followed from age 15 to 70 years and their infants followed from birth to age 20 years. Accounting for differences in parity, maternal age, and birth weights by race/ethnicity, we examined disease outcomes and costs using 2012 breastfeeding rates by race/ethnicity and outcomes that would be expected if 90% of infants were breastfed according to recommendations for exclusive and continued breastfeeding duration. RESULTS Suboptimal breastfeeding is associated with a greater burden of disease among NHB and Hispanic populations. Compared with a NHW population, a NHB population had 1.7 times the number of excess cases of acute otitis media attributable to suboptimal breastfeeding (95% CI 1.7-1.7), 3.3 times the number of excess cases of necrotizing enterocolitis (95% CI 2.9-3.7), and 2.2 times the number of excess child deaths (95% CI 1.6-2.8). Compared with a NHW population, a Hispanic population had 1.4 times the number of excess cases of gastrointestinal infection (95% CI 1.4-1.4) and 1.5 times the number of excess child deaths (95% CI 1.2-1.9). CONCLUSIONS Racial/ethnic disparities in breastfeeding have important social, economic, and health implications, assuming a causal relationship between breastfeeding and health outcomes.
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Affiliation(s)
- Melissa C Bartick
- Department of Medicine, Cambridge Health Alliance, Harvard Medical School, Cambridge, MA.
| | - Briana J Jegier
- Department of Health Services Administration, D'Youville College, Buffalo, NY
| | - Brittany D Green
- Department of Operations Business Analytics and Information Systems, University of Cincinnati, Cincinnati, OH
| | | | | | - Alison M Stuebe
- Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, NC; Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina School of Medicine, Chapel Hill, NC
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10
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Bartick MC, Schwarz EB, Green BD, Jegier BJ, Reinhold AG, Colaizy TT, Bogen DL, Schaefer AJ, Stuebe AM. Suboptimal breastfeeding in the United States: Maternal and pediatric health outcomes and costs. Matern Child Nutr 2017; 13:e12366. [PMID: 27647492 PMCID: PMC6866210 DOI: 10.1111/mcn.12366] [Citation(s) in RCA: 205] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Revised: 07/02/2016] [Accepted: 07/20/2016] [Indexed: 12/29/2022]
Abstract
The aim of this study was to quantify the excess cases of pediatric and maternal disease, death, and costs attributable to suboptimal breastfeeding rates in the United States. Using the current literature on the associations between breastfeeding and health outcomes for nine pediatric and five maternal diseases, we created Monte Carlo simulations modeling a hypothetical cohort of U.S. women followed from age 15 to age 70 years and their children from birth to age 20 years. We examined disease outcomes using (a) 2012 breastfeeding rates and (b) assuming that 90% of infants were breastfed according to medical recommendations. We measured annual excess cases, deaths, and associated costs, in 2014 dollars, using a 2% discount rate. Annual excess deaths attributable to suboptimal breastfeeding total 3,340 (95% confidence interval [1,886 to 4,785]), 78% of which are maternal due to myocardial infarction (n = 986), breast cancer (n = 838), and diabetes (n = 473). Excess pediatric deaths total 721, mostly due to Sudden Infant Death Syndrome (n = 492) and necrotizing enterocolitis (n = 190). Medical costs total $3.0 billion, 79% of which are maternal. Costs of premature death total $14.2 billion. The number of women needed to breastfeed as medically recommended to prevent an infant gastrointestinal infection is 0.8; acute otitis media, 3; hospitalization for lower respiratory tract infection, 95; maternal hypertension, 55; diabetes, 162; and myocardial infarction, 235. For every 597 women who optimally breastfeed, one maternal or child death is prevented. Policies to increase optimal breastfeeding could result in substantial public health gains. Breastfeeding has a larger impact on women's health than previously appreciated.
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Affiliation(s)
- Melissa C. Bartick
- Department of MedicineCambridge Health AllianceCambridgeMassachusetts
- Harvard Medical SchoolBostonMassachusetts
| | | | - Brittany D. Green
- Department of Operations Business Analytics and Information SystemsUniversity of CincinnatiCincinnatiOhio
| | - Briana J. Jegier
- Department of Health Services AdministrationD'Youville CollegeBuffaloNew York
| | | | - Tarah T. Colaizy
- Department of NeonatologyCarver College of Medicine, University of IowaIowaIowa
| | - Debra L. Bogen
- Department of PediatricsUniversity of PittsburghPittsburghPennsylvania
| | - Andrew J. Schaefer
- Department of Computational and Applied MathematicsRice UniversityHoustonTexas
| | - Alison M. Stuebe
- Department of Obstetrics and Gynecology, School of MedicineUniversity of North Carolina at Chapel HillChapel HillNorth Carolina
- Carolina Global Breastfeeding Institute, Department of Maternal and Child Health, Gillings School of Global Public HealthUniversity of North Carolina at Chapel HillChapel HillNorth Carolina
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11
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Colaizy TT, Bartick MC, Jegier BJ, Green BD, Reinhold AG, Schaefer AJ, Bogen DL, Schwarz EB, Stuebe AM. Impact of Optimized Breastfeeding on the Costs of Necrotizing Enterocolitis in Extremely Low Birthweight Infants. J Pediatr 2016; 175:100-105.e2. [PMID: 27131403 PMCID: PMC5274635 DOI: 10.1016/j.jpeds.2016.03.040] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Revised: 02/01/2016] [Accepted: 03/16/2016] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To estimate risk of necrotizing enterocolitis (NEC) for extremely low birth weight (ELBW) infants as a function of preterm formula (PF) and maternal milk intake and calculate the impact of suboptimal feeding on the incidence and costs of NEC. STUDY DESIGN We used aORs derived from the Glutamine Trial to perform Monte Carlo simulation of a cohort of ELBW infants under current suboptimal feeding practices, compared with a theoretical cohort in which 90% of infants received at least 98% human milk. RESULTS NEC incidence among infants receiving ≥98% human milk was 1.3%; 11.1% among infants fed only PF; and 8.2% among infants fed a mixed diet (P = .002). In adjusted models, compared with infants fed predominantly human milk, we found an increased risk of NEC associated with exclusive PF (aOR = 12.1, 95% CI 1.5, 94.2), or a mixed diet (aOR 8.7, 95% CI 1.2-65.2). In Monte Carlo simulation, current feeding of ELBW infants was associated with 928 excess NEC cases and 121 excess deaths annually, compared with a model in which 90% of infants received ≥98% human milk. These models estimated an annual cost of suboptimal feeding of ELBW infants of $27.1 million (CI $24 million, $30.4 million) in direct medical costs, $563 655 (CI $476 191, $599 069) in indirect nonmedical costs, and $1.5 billion (CI $1.3 billion, $1.6 billion) in cost attributable to premature death. CONCLUSIONS Among ELBW infants, not being fed predominantly human milk is associated with an increased risk of NEC. Efforts to support milk production by mothers of ELBW infants may prevent infant deaths and reduce costs.
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MESH Headings
- Breast Feeding/economics
- Enterocolitis, Necrotizing/economics
- Enterocolitis, Necrotizing/epidemiology
- Enterocolitis, Necrotizing/prevention & control
- Health Care Costs/statistics & numerical data
- Humans
- Infant Formula/economics
- Infant, Extremely Low Birth Weight
- Infant, Newborn
- Infant, Premature
- Infant, Premature, Diseases/economics
- Infant, Premature, Diseases/epidemiology
- Infant, Premature, Diseases/prevention & control
- Milk, Human
- Models, Economic
- Monte Carlo Method
- United States/epidemiology
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Affiliation(s)
- Tarah T Colaizy
- Carver College of Medicine, University of Iowa, Iowa City, IA.
| | - Melissa C Bartick
- Department of Medicine, Cambridge Health Alliance and Harvard Medical School, Cambridge, MA
| | | | - Brittany D Green
- Department of Industrial Engineering, University of Pittsburgh, Pittsburgh, PA
| | | | - Andrew J Schaefer
- Department of Computational and Applied Mathematics, Rice University, Houston, TX
| | - Debra L Bogen
- Department of Pediatrics, University of Pittsburgh, Pittsburgh, PA
| | | | - Alison M Stuebe
- Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, NC; Carolina Global Breastfeeding Institute, Gillings School of Global Public Health, Chapel Hill, NC
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12
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Affiliation(s)
- Melissa C Bartick
- Assistant Professor, Harvard Medical School and Cambridge Health Alliance
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13
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Feldman-Winter L, Douglass-Bright A, Bartick MC, Matranga J. The new mandate from the joint commission on the perinatal care core measure of exclusive breast milk feeding: implications for practice and implementation in the United States. J Hum Lact 2013; 29:291-5. [PMID: 23599268 DOI: 10.1177/0890334413485641] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Abstract
BACKGROUND Hospital routines frequently interrupt nighttime sleep. Sedatives promote sleep, but increase the risk of delirium and falls. Few interventional trials have studied sleep promotion in medical-surgical units and little is known about its impact on sedative use. OBJECTIVE To determine causes of sleep disruption, and assess whether decreasing sleep disruptions lowers sedative use in medical-surgical patients. DESIGN AND SETTING Interventional trial with historical controls on a medical-surgical unit of a community teaching hospital. Nurses, physicians, and patients were blinded to the measurement of as-needed sedative use. PATIENTS Consecutive eligible adults (n = 161 preintervention patients, n = 106 intervention patients). INTERVENTION We developed the "Somerville Protocol," which included the establishment of an 8-hour "Quiet Time" that began with automated lights-off and lullaby; staff-monitored noise; and avoidance of waking of patients for routine vital signs and medications. MEASUREMENTS As-needed sedative use, responses to a patient questionnaire, and responses to a modified Verran Snyder-Halpern (VSH) sleep scale. RESULTS Preintervention, "hospital staff " was the disturbance most likely to keep patients awake. The intervention decreased the proportion of patients reporting it from 42% to 26%, a 38% reduction (P = 0.009; 95% confidence interval [CI]: 0.0452-0.2765). Preintervention, 32% of patients received as-needed sedatives, compared to 16% with the intervention, a 49% reduction (P = 0.0041; 95% CI: 0.056-0.26), with a 62% decrease in patients over age 64 years (P = 0.005). VSH scores were unchanged. CONCLUSIONS Small modifications in hospital routines, especially in the timing of vital signs and routine medication administration, can significantly reduce sedative use in unselected hospital patients.
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Affiliation(s)
- Melissa C Bartick
- Department of Medicine, Harvard Medical School, Cambridge Health Alliance, Cambridge, Massachusetts 02139, USA.
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