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Metabolic Acidosis in Preterm Infants is Associated with a Longer Length of Stay in the Neonatal Intensive Care Unit


  • Marika Paul

    (Abbott Nutrition R&D)

  • Jamie Partridge

    (Abbott Nutrition R&D)

  • Bridget Barrett-Reis

    (Abbott Nutrition R&D)

  • Kaashif A. Ahmad

    (North Central Baptist Hospital)

  • Pattabhi Machiraju


  • Hemalatha Jayapalan


  • Richard J. Schanler

    (Cohen Children’s Medical Center)


Introduction Preterm births account for disproportionately high healthcare costs, in large part due to expenses related to length of stay in the hospital neonatal intensive care unit (NICU). It is common for preterm infants to receive human milk fortifier (HMF) while in the NICU. Liquid HMF is available in both acidified and non-acidified formulations. A recent randomized clinical trial found that acidified HMF is associated with an increased incidence of metabolic acidosis, which may contribute to increased costs and longer NICU length of stay. Objective The present study is a secondary analysis of these data, seeking to determine whether additional factors contribute to metabolic acidosis, whether metabolic acidosis is associated with longer hospital length of stay, and whether these associations contribute to the burden of hospital costs. Methods The study sample consisted of 152 infants who were hospitalized in US NICUs. Multiple logistic regression was used to model the NICU length of stay. Data from the 2012 Healthcare Cost and Utilization Project (HCUP) Kids’ Inpatient Database (KID) were used to calculate the average cost (charge) per day in a NICU. Costs (charges) were adjusted to $US, year 2018 values, using the health Consumer Price Index. Result Results indicated that acidified HMF was a strong predictor of metabolic acidosis, more so than gestational age or birth weight. Furthermore, metabolic acidosis was associated with incremental NICU costs (charges) of $US19,002 ($US65,462) per infant and longer NICU LOS. Conclusion Future studies should further investigate factors that contribute to NICU length of stay and associated costs of care. Trial Registration NCT02307760.

Suggested Citation

  • Marika Paul & Jamie Partridge & Bridget Barrett-Reis & Kaashif A. Ahmad & Pattabhi Machiraju & Hemalatha Jayapalan & Richard J. Schanler, 2020. "Metabolic Acidosis in Preterm Infants is Associated with a Longer Length of Stay in the Neonatal Intensive Care Unit," PharmacoEconomics - Open, Springer, vol. 4(3), pages 541-547, September.
  • Handle: RePEc:spr:pharmo:v:4:y:2020:i:3:d:10.1007_s41669-020-00194-y
    DOI: 10.1007/s41669-020-00194-y

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    1. Rita Faria’s journal round-up for 14th September 2020
      by Rita Faria in The Academic Health Economists' Blog on 2020-09-14 11:00:07

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