Benefits of breast milk
Time to read: 4 min.
Necrotizing enterocolitis (NEC) is one of the most devastating gastrointestinal diseases affecting premature and very low birth weight (VLBW) infants1,2 and is the most common cause of death between 2 weeks and 2 months of age in extremely preterm infants.3 It affects around 7.6% of VLBW infants,2 carrying a mortality rate of 30.1%.1
Characterized by inflammation and necrosis of the intestinal tissue, NEC can lead to severe complications, including sepsis, intestinal perforation, and death.4 Additionally, neurodevelopmental disability in infants affected by NEC has been reported at between 24.8% and 61.1%.1 Survivors of NEC and parents of children affected by NEC experience long-term complications that impact their physical and mental health, social experiences, and quality of life.5 Beyond this, the economic burden of NEC on healthcare systems is substantial, with incremental NICU hospitalization costs of 46,103 USD due to longer NICU length of stay and increased resource use.6
Clinical evidence underscores the powerful role of human milk—both mother’s own milk (MOM) and donor human milk (DHM)—in significantly reducing the incidence and severity of NEC and its associated healthcare costs.6,7 Avoiding formula and providing only human milk during the first two weeks of life has been shown to significantly lower the risk of NEC and reduce associated NICU expenses in VLBW infants.7 Introducing even small amounts of formula during this critical period increases the likelihood of NEC by more than three times.7 Hospitals that implement guidelines to ensure exclusive human milk feeding in the first 14 days can achieve substantial savings in NEC-related NICU costs.
The cost-effectiveness of human milk is further amplified when considering the broader society. Infants who avoid NEC are less likely to suffer from neurodevelopmental disability and other long-term health problems, which can lead to lifelong healthcare and educational costs.
From an economic standpoint, human milk is not just a nutritional choice—it is a cost-effective medical intervention. A recent systematic review8 analyzed 14 studies across the United States, Germany, and Canada, all of which evaluated the economic impact of human milk for very preterm infants. The majority of these studies concluded that human milk interventions were either cost-saving or cost-effective, especially when considering the high costs associated with NEC treatment and long-term complications.
Despite these benefits, access to donor human milk remains inconsistent across healthcare systems, often due to funding limitations or lack of infrastructure. Within the United States, recent mPINC survey data show that 100% Level IV NICUs surveyed and 92% of Level III NICUs provide donor milk for premature infants, while only 45% of Level II NICUs have donor milk programs.9
Although research has demonstrated a reduction in the incidence and severity of NEC with DHM rather than formula supplementation, unlike MOM, DHM does not have an impact on the incidence or severity of other prematurity-related morbidities such as late onset sepsis and bronchopulmonary dysplasia.10,11 Furthermore, MOM is less expensive to acquire than DHM.10,12 Given that VLBW infants are among the most resource-intensive patients, investing in programs that promote the use of MOM should be a NICU priority.6,10
The economic value of human milk in preventing NEC is clear and compelling. By reducing the incidence of a life-threatening and costly condition, human milk not only improves clinical outcomes for the most vulnerable infants but also delivers significant cost savings to hospitals and healthcare systems. As evidence continues to emerge, prioritizing support for MOM feeding in the NICU may represent one of the most impactful and economically sound strategies in modern neonatology.
1. Jones IH, Hall NJ. Contemporary Outcomes for Infants with Necrotizing Enterocolitis - A Systematic Review. J Pediatr. 2020; 220:86-92.e3.
2. Han SM et al. Trends in incidence and outcomes of necrotizing enterocolitis over the last 12 years: A multicenter cohort analysis. J Pediatr Surg. 2020; 55(6):998–1001.
3. Patel RM et al. Causes and timing of death in extremely premature infants from 2000 through 2011. N Engl J Med. 2015; 372(4):331–340.
4. Neu J, Walker WA. Necrotizing enterocolitis. N Engl J Med. 2011; 364(3):255–264.
5. Canvasser J et al. Long-term outcomes and life-impacts of necrotizing enterocolitis: A survey of survivors and parents. Seminars in Perinatology. 2023; 47(1):151696.
6. Johnson TJ et al. Cost Savings of Mother's Own Milk for Very Low Birth Weight Infants in the Neonatal Intensive Care Unit. Pharmacoecon Open. 2022; 6(3):451–460.
7. Johnson TJ et al. Cost savings of human milk as a strategy to reduce the incidence of necrotizing enterocolitis in very low birth weight infants. Neonatology. 2015; 107(4):271–276.
8. Lu A et al. Economic evaluations of human milk for very preterm infants: a systematic review. Front Pediatr. 2025; 13:1534773.
9. Anstey E et al. Maternity care practices supportive of breastfeeding in U.S. advanced neonatal care units, United States, 2022. J Perinatol. 2024; 44(11):1560–1566.
10. Meier P et al. Donor human milk update: evidence, mechanisms, and priorities for research and practice. J Pediatr. 2017; 180:15–21.
11. Quigley M et al. Formula versus donor breast milk for feeding preterm or low birth weight infants. Cochrane Database Syst Rev. 2019; 7(7):CD002971.
12. Johnson TJ et al. The Economic Impact of Donor Milk in the Neonatal Intensive Care Unit. J Pediatr. 2020; 224:57-65.e4.
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