1. A VALUE ADDED STRATEGY TO IMPROVING
NEONATAL NUTRITIONAL SUPPORT AND RELATED OUTCOMES Deborah J. Tuttle, MD; Mary Ann Williams, MA, RD; Gina H. Moore, BSN, CPHQ;
Amy Mackley, MSN, RNC and John L. Stefano, MD
Christiana Care Health System, Newark, DE
BACKGROUND
Necrotizing Enterocolitis (NEC) is one of the most common gastrointestinal emergencies in the newborn infant. It is a disorder characterized by ischemic necrosis of the intestinal mucosa. NEC accounts for substantial long-term morbidity in survivors of neonatal intensive care, particularly in premature very low birth weight infants.
An exclusive human milk diet has been shown to reduce NEC. At our institution, infants at highest risk for NEC receive maternal breast milk or donor breast milk, traditionally fortified with a bovine milk based fortifier. Our NEC rates have been below the Vermont Oxford average.
A fortifier made from human donor milk became commercially available but added significant cost - an average of $5600 additional cost per patient in our NICU. A multidisciplinary team began to investigate the feasibility of providing an exclusive human milk diet, including fortification, as a strategy to further lower the rate of NEC.
DESIGN/METHODS
A multidisciplinary team developed the protocol which defined patient population, timing and length of fortification, and outcome measures.
NEC rates are tracked as part of our institution’s VON data collection.
Fortification was switched from bovine to human milk based product in October 2010.
All eligible patients received the product, after consent.
NEC rates continue to be monitored post fortifier change.
RESULTS (continued)
Nov 09-Oct 10
Nov 10-Oct 12
#<1250 gm
128
206
# bovine fortifier 92
# HBM fortifier
160
All NEC (surgical)
12 (1)
7 (0)
Bovine Fortifier Assoc. NEC (surgical)
8 (1)
HBM Fortifier Assoc. NEC (surgical)
2 (0)
COST ANALYSIS
Nov 10 – Oct 12: 160 infants received HBM derived fortifier
Fortifier Cost -= $896,000
Published estimate: Cost /NEC case = $175,000
Nov 10 – Oct 12: 6 fewer fortifier associated NEC cases
Cost savings: $1,050,000
RESULTS
CONCLUSIONS
Use of a human donor milk based fortifier resulted in a reduction of NEC, improving patient outcomes and reducing NICU costs.
Stewardship of an expensive resource can add value and cost savings in NICU care.
These data could be helpful in negotiating third party coverage for this expensive resource.
OBJECTIVES
Understand the impact of an exclusive human diet on the incidence of NEC in our high risk patients
List the key measures used to evaluate this performance improvement initiative
Understand how expensive interventions can add value and cost savings when stewardship is utilized.
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