OBJECTIVES: When mother’s own milk (MOM) is not available or in short supply, pasteurized donor human milk is the recommended alternative for very low birth weight (VLBW, birth weight <1500g) infants. Donor milk has been shown to reduce the risk of necrotizing enterocolitis (NEC) relative to infant formulas. While donor milk is becoming the standard of care for VLBW infants when MOM is unavailable, little is known about the NICU hospitalization costs associated with MOM diets supplemented with donor milk feedings versus MOM diets supplemented with formula.

METHODS: This was a retrospective study of 338 infants born before (January 2011 – December 2012, MOM+formula) and after implementation of a donor human milk program (April 2013 – March 2015, MOM+DM) in the Rush University Medical Center NICU. Data were retrieved from a prospectively-collected research database, the electronic medical record, and the hospital’s cost accounting system. Resource-level hospital and physician costs were used to calculate the total hospital cost of the NICU stay. A multivariable generalized linear regression model with a log link function and gamma distribution was fit, controlling for infant and maternal characteristics.

RESULTS: The mean proportion of MOM for the NICU stay was 45.2% for MOM+formula and 47.1% for MOM+donor milk (p=0.683). The incidence of NEC (stage ≥2) was 3.7% vs. 1.3% (p=0.117), respectively. Total hospital cost was $174,524 (2016 USD) and NICU length of stay was 78 days for MOM+formula, and $191,641 and 85 days for MOM+donor milk.

CONCLUSIONS: We found no evidence of a reduction in the cumulative dose of MOM for infants in the MOM+donor milk group compared to infants in the MOM+formula group. While there was a reduction in NEC, we found no significant difference in hospital costs between groups. We speculate that the costs associated with NEC were offset by the costs associated with DM purchase.