When mothers deliver their babies prematurely, they should have every confidence that hospitals are providing the best care for their fragile infants. Despite advances in nutrition, families may be surprised to know that infants do not always have access to the best possible options.
In my 17 years as a neonatologist in Pennsylvania, I have seen how economic barriers have impacted varying adoptions of an exclusive human milk diet at different institutions —beyond the control of our wonderful hospitals and neonatologists. Too often, this issue disproportionately affects our most vulnerable and economically disadvantaged families. It’s time for this to change.
Fortunately, there is an opportunity for an important reform. When considering SB 500 or HB 1111, the Pennsylvania Legislature must include Medicaid coverage for donor breastmilk and human milk-based fortifiers. With this change, we will join Ohio, New York, and New Jersey which already provide this coverage.
Here’s the background: access to proper nutrition for early development is critical, especially for very low birthweight (VLBW) babies that start life in the NICU. When a mother is unable to produce sufficient breast milk for her premature newborn, physicians prefer human milk products over cow’s milk-based products. Unfortunately, not all of these infants receive an exclusive human milk diet, putting them at risk for life-threatening complications.
For babies born as premature as 23 weeks and who can fit in the palm of your hand, milk alone is not enough to ensure they receive the proper nutrition for growth missed in utero. Fortifier is a supplement that is added to breastmilk, containing extra calories, protein, and vitamins to promote growth in the first weeks of life. Fortifiers can be made from human breast milk or cow’s milk. However, human breastmilk fortifier, not cow’s milk fortifier, is a key part of the exclusively human milk-based diet recommended for premature infants when they are most susceptible to life-threatening diseases, such as necrotizing enterocolitis (NEC). Many babies do not receive these products because they are not covered by Medicaid.
Why does an exclusive human milk diet matter? Babies born prematurely often do not have fully developed digestive systems and are unable to digest foreign proteins. Preterm infants born very low birthweight account for 70% of neonatal deaths and one of the most common causes of death among these babies is NEC. Risk of NEC can be reduced significantly when VLBW babies are fed an exclusive human milk diet. SB 500 and HB 1111 must be amended to ensure Medicaid pays for an exclusive human milk diet for infants in need. Specifically, this means including coverage for human milk-based fortifiers.
Medicaid paid for 51.2% of births for VLBW babies in 2021 and amending this bill would go a long way toward helping vulnerable babies while saving the Commonwealth money. A recent study evaluating feeding regimens in diverse NICUs throughout the country showed that hospitals had better clinical outcomes for VLBW infants who were fed an exclusively human milk diet compared to a diet that was not exclusively human milk. These NICUs realized annual cost savings between $515,113 and $3,369,515[1] by implementing an exclusively human milk diet. Indeed, hospitals reported fewer illnesses in these babies, including the total NEC rate, chronic lung disease, visual impairments from prematurity, and late-onset sepsis. Because of these improvements in health, healthcare costs decreased due to shorter lengths of stay and fewer clinical treatments required for extremely premature babies.
Pennsylvania is lagging behind other states that already cover these products. For the sake of our families: Please amend SB 500 or HB 1111 to include Medicaid coverage for an exclusive human milk diet for fragile preemies.
Dr. Chang is the Chief of the Division of Neonatology, Abington-Jefferson Health and Clinical Assistant Professor of Pediatrics at Sidney Kimmel Medical College of Thomas Jefferson University.