Evaluating the Health-Economic Benefit of Usage of Human Milk Fortifier – A Physician Reported Survey Outcome: HERO Study

Purpose: This survey aims to provide insights into analyse the association of providing human milk fortification with growth outcomes, early hospital discharge, and the impact on economic outcomes associated with the management of neonates in the NICU setting. Methods: A survey-based analysis was conducted in five hospitals, which were included based on the number of NICU beds, patient volume, and practice of using human milk fortifier for neonates. The survey consisted of 22 questions, which were designed to understand the hospital infrastructure, patient volume, feeding practices for neonates, economic burden, and clinical outcomes in the NICU settings, and was duly filled by the physicians. The average response for each survey question was calculated and further analysed. Results: The survey results report that of all the hospitalized neonates, 75% (7.5/10) are admitted to NICU, and 60% (6/10) receive feeds with human milk fortifier (HMF), while 23% receive unfortified feeds. A higher weight gain of ~10– 20 gm/kg/d and an estimated 40% lesser days of NICU stay are observed in neonates provided with HMF (approximately 9 days) while neonates receiving unfortified feeds stay for approximately 15 days. Average per day NICU cost for management of a neonate is estimated to be INR 30,000, which amounts to 4.5 lac for 15 days and 2.7 lac for 9 days when provided with unfortified and fortified feeds, respectively, while keeping the costs consistent till discharge. However, the hospitals generally incur a ~25– 30% higher expense as compared to later days, so, an early discharge can turn into estimated potential savings of 30– 40% per month for the hospital. Conclusion: The survey findings suggest utilizing human milk fortifiers during neonatal care in the NICU, may translate into reduced length of stay, and potential health and economic benefits that encompass the baby, the caregiver, and the hospital. Keywords: human milk fortifier, HMF, neonatal intensive care unit, NICU, extrauterine growth restriction, EUGR, necrotizing enterocolitis. NEC