1. Hospital Financial Assessment

2. Annual Cost of NEC Reference: Pediatrics 2002;109,423-428;Impact of Necrotizing Enterocolitis on Length of Stay and Hospital Charges in Very Low Birth Weight Infants -Chart based on taking 40% of the NEC population requiring surgery and 60% having Medical NEC -VON reports that 12% of patient population under 27 weeks develop NEC and 2% over the entire NICU population Mortality Rates for NEC Range from 20-40% of All cases

3. Increased Breastmilk Usage Translating into Savings Exclusively formula fed babies are 6-7 more times likely to develop NEC than exclusively breastmilk fed babies and 3 times more likely than those receiving both. (Graph assumes a 7x increase) Chart Based on VON data of ~50% as a baseline of Population receiving some breastmilk by discharge Baseline NEC rates are on the bottom and are represented with the 50% BF rate. By increasing the BF rates, the NEC percentages decrease Based Hospital Admission of 500 annually Baseline 1%NECBaseline 3%NECBaseline 5%NECBaseline 7%NECBaseline 10%NEC 0 1,000,000 2,000,000 3,000,000 4,000,000 5,000,000 6,000,000 Hospital Incurred Cost ($$) 50% BF Rate Baseline 60% BF Scenario 70% BF Scenario 80% BF Scenario 90% BF Scenario 100% BF Scenario

4. NEC Medical NEC –exhibits signs/symptoms without perforation –Adds 22 additional days to LOS –Increases death by 14% –Overall hospital charges $300,000 $73K in incremental hospital charges Surgical NEC –radiographic evidence of perforated bowel –Adds 60 additional days to LOS –Increases death by 24.5% –Overall hospital charges $450,000 $190K in incremental hospital charges

5. Additional Benefits of Breastmilk in the NICU OutcomeFortified HM Preterm Formula O2 Therapy (days)19+2133+41 NEC (n)1(1.6%)6(13%) Surgical NEC (n)03 Late-Onset Sepsis n, (%) 19(31%)22(48%) Late-Onset Sepsis # of episodes/patient 0.3+0.50.6+0.7 Positive Blood Cultures (#/infant) 0.5+0.91.2+1.7 NEC or Sepsis, n (%)19(31%)25(54%) GERD Medications (%) 16%39% Schanler et al., Pediatrics 103, 1999;1150-1157 For every 10-ml/kg per day increase in Breastmilk ingestion: The Mental Development Index Increased by 0.53 points The Psychomotor Development Index increased by 0.63 points Behavior Rating Scale Percentile Score increased by 0.82 points Likelihood of rehospitalization decreased by 6% Vohr et al., Beneficial effects of breastmilk in the neonatal intensive care unit on the developmental outcome of extremely low birthweight infants at 18 months of age; Pediatrics 2006;118;e115-e123

6. Impact of a Strong Lactation Program for Neonates 2 Year Study Performed at Children’s Hospital of the King’s Daughters in Norfolk, VA Gonzalez et al.,Journal of Human Lactation 2003:19:286 Usual Support encompassed period between 1996-1998 when no lactation support was available IBCLC Support encompassed 2 full time IBCLC’s with RN backgrounds and a 3 rd in training

7. Cost Benefit of a NICU Lactation Program Lactation FTE’s – Assume $100,000 (Salary + Benefits) Assume RN with IBCLC Assume 2 FTE = $200,000 PumpsNo Charge KitsBased on 500 Annual Admissions 80% Breastfeeding Rate Total Kits Consumed 400 + 20% contingency for replacements Total Kits Consumed 480 $13,000 Annually ContainersAssume Annual Usage of 140,000 units Annual Cost = $35,000 Total Cost:$257,000 annually

8. References