P1.184: Single Center Retrospective Analysis of Preterm Infants: Association of Feeding Type on Disparities, Healthcare Complications, and Discharge Outcomes

Background: Enteral feeding type plays a critical role in determining health outcomes for preterm infants. Mother’s own milk (MOM), the optimal nutrition source for preterm infants, reduces the incidence of necrotizing enterocolitis (NEC) when compared to formula in this population, and smaller studies have also shown benefits with MOM in the incidence of retinopathy of prematurity (ROP) and bronchopulmonary dysplasia (BPD). If MOM is unavailable or insufficient, donor human milk (DHM) or formula may be used. Previous studies have not examined the role of feeding type on neonatal intensive care (NICU) discharge outcomes and healthcare utilization. This study aims to evaluate the impact of feeding type (MOM, DHM, or formula) on length of stay in the NICU and complications during hospitalization and at discharge that contribute to increased healthcare expenses.

Methods: This is a retrospective cohort study on premature infants born at 22 0/7 weeks to 34 6/7 weeks gestational age between January 1, 2018 and December 31, 2022 at Texas Children’s Hospital. Outborn infants, those with major congenital anomalies, and those without predominant feeding type were excluded. All parents were allowed to use DHM if desired, and feeds were advanced based on institutional feeding protocol. Infants were categorized by predominant feeding type if they received greater than 50% MOM, DHM, or formula during the entire hospitalization. IRB approval was obtained. Median household income was obtained based on zip code by United States census data for the respective years of this study. The Kruskal-Wallis test compared the three feeding type groups for quantitative variables; the Chi-square test was used for categorical variables. To control for confounders, infant demographic and maternal disparity variables that differed significantly across feeding types (birth weight, maternal race, English language, insurance type, and household income) were included in multivariable regression models for increased healthcare utilization.

Results: 1903 infants met inclusion and exclusion criteria. The formula group had the highest median gestational age and birth weight, and the MOM group was disproportionally represented by White, English-speaking, and commercial insurance mothers from households in higher-income areas (Table 1). In the adjusted analysis, the formula group had the highest median NICU length of stay and the highest rates of oxygen use at discharge, anti-vascular endothelial growth factor (anti-VEGF) therapy for ROP, and surgery for patent ductus arteriosus (PDA) and NEC (Table 2).

Conclusion: In this cohort of preterm infants over a 5-year period, predominant formula use was associated with longer length of NICU stay and increased surgical intervention for NICU morbidities, even after controlling for birth weight, language, race, insurance type, and income. Predominant use of human milk may reduce short- and long-term healthcare expenses for this vulnerable population.