Table 1. Economic Barriers to the Initiation and Maintenance of Lactation: Estimated Average Cost of Required Services per Infant.
| Barrier | Cost per Infant | Low | High | Assumptions |
|---|---|---|---|---|
| 1 Provision of professionally-produced, evidence-based materials targeting the importance of HM for preterm infants + monitoring of HM volume and goals for HM feeding | Brochure + education sheets = $10; Mother’s Milk Volumes (MMV) record = $5.50; Maternal Goals record = $0.10; |
$15.60 | $15.60 | 1 set of materials per infant |
| 2 Hospital grade electric breast pump rental for 3 months (through term, corrected age) | $40 to $70 per month | $120.00 | $210.00 | 3 month rental; low estimate assumes $40 per month, wholesale cost; high estimate assumes $70/month retail cost |
| 3 Provision of pump kit | $32.91 cost per kit | $32.91 | $32.91 | 1 kit per infant |
| 4 Access to custom-fitted breast shields for effective, efficient and comfortable HM removal | $7 retail cost | $7.00 | $7.00 | 1 set per infant |
| 5 Provision of sufficient numbers of hospital-grade HM storage containers for pumped HM | $0.21 cost per container (Jegier 2013) | $89.46 | $134.19 | Low estimate assumes 6 containers per day (350 mL/120 * 1.2 rounded to next multiple of 3); high estimate assumes 9 containers/day (700 mL/120 *1.2 rounded to next multiple of 3); for 71-day NICU stay |
| 6 Access to NICU-specific lactation support from NICU-based certified breastfeeding peer counselors (BPC) during coming to volume, weekly group forums and on an individual basis, as needed | $18/hour + 26% fringe benefits | $417.11 | $539.79 | 71-day NICU stay; $18/hour + 26% fringe benefits; low estimate assumes 2 BPC for 44 infants per day; high estimate assumes 2 BPC for 33 infants per day (75%) |
| 7 Availability of NICU freezers for safe storage of all pumped HM (e.g., not telling mothers to store HM in the home and bring it in as needed) | $8,000 cost per freezer | $6.92 | $10.37 | Storage for 15 infants per freezer; low estimate assumes 15 year life; high estimate assumes 10 year life; for 71 day length of NICU stay |
| 8 Use of HM waterless warmers to avoid HM contamination with waterborne pathogens | $773 cost per warmer | $30.07 | $50.12 | 1 warmer per infant for 71-day NICU stay; low estimate assumes 5 year life; high estimate assumes 3 year life |
| 9 Use of liners for waterless warmer | $3.25 cost per liner | $230.75 | $230.75 | 1 liner per day for 71-day NICU stay |
| 10 Basic creamatocrit and/or other HM analysis technology to individualize HM feedings and HM collection strategies | $1,500 per creamatocrit | $0.38 | $0.63 | 1 creamatocrit per NICU; assumes 800 NICU admissions per year; low estimate assumes 5 year life; high estimate assumes 3 year life |
| 11 Availability of infant scales for measuring HM intake during breastfeeding | $1,500 per scale | $3.89 | $6.48 | 1 scale per 15 infants for NICU stay; low estimate assumes 5 year life; high estimate assumes 3 year life |
|
| ||||
| Total | $954.08 | $1,237.84 | ||
Costs reported in 2015 US dollars.
Based on Average length of NICU stay for VLBW infants of 71 days from RUMC data