Trial Reveals Racial Disparities in Fatal Intestinal Disease Among Preterm Babies
Jasmine Watson of Fairview Heights became the first mother whose premature baby died from necrotizing enterocolitis (NEC) to take a formula company to trial. Watson’s son Chance Dean, one of the twins born in March 2020, developed NEC after receiving cow’s milk-based formula at Memorial Hospital in Shiloh, where donor breast milk wasn’t available. The infant died just 25 days after birth, following three surgeries to combat the rapidly progressing intestinal disease. Medical experts testifying at the trial highlighted that minority mothers like Watson face disproportionately higher risks of both premature births and NEC incidence among their infants.
5 Key Points
- NEC kills approximately one premature infant daily in the United States, accounting for 10% of all NICU deaths.
- Minority mothers and infants face significantly higher rates of both premature births and NEC incidence.
- Only 18 states provide insurance coverage for donor human milk, creating access disparities.
- Watson’s lawsuit is one of hundreds against Mead Johnson and Abbott formula manufacturers.
- Medical experts confirm breast milk or donor human milk significantly reduces NEC risk compared to cow’s milk formula.
Why are minority babies at higher risk for NEC?
Dr. Ravi Patel, professor of pediatrics at Emory University and co-author of a 2023 study on NEC racial disparities, provided critical insight into the disease’s disproportionate impact. “It’s a quick killer, and it is one that most people haven’t heard about,” Patel stated during testimony. “Racial disparities are a big challenge. We know that preterm birth disproportionately affects Black mothers and Black infants, and NEC is the same. NEC has substantial racial disparity.”
The lawsuit highlights these disparities, noting Watson is Black, as are a majority of parents whose children contract NEC. While the exact reasons for this disparity remain complex, Patel noted some progress: “Although that disparity has gotten narrower over time, that has still persisted, and some of that is related to differences in preterm birth, just more babies who are born preterm that are Black.”
Watson’s experience reflects the brutal reality of NEC, which causes sudden inflammation of the intestines. After the twins’ birth at Barnes Jewish Hospital, Chance was transferred to Memorial Hospital in Shiloh approximately nine days before his death. Unlike St. Louis Children’s Hospital, where the infant spent half his short life, Memorial Hospital did not provide donor human milk to NICU patients.
What are the symptoms of NEC, and who qualifies for lawsuits?
Parents of premature infants should be vigilant for NEC symptoms, which can develop rapidly and require immediate medical attention. Key warning signs of necrotizing enterocolitis include:
- Feeding intolerance (difficulty taking or keeping formula down)
- Abdominal distention (swollen, tender, or discolored belly)
- Vomiting, especially bile-stained (greenish) vomit
- Bloody stools
- Lethargy or decreased activity
- Temperature instability (inability to maintain normal body temperature)
- Decreased urination
- Bradycardia (slowed heart rate) or apnea (pauses in breathing)
Families may qualify for legal action against formula manufacturers if their premature infant:
- Consumed cow’s milk-based formula products such as Similac or Enfamil while in the NICU
- Developed NEC symptoms after formula feedings
- Received a formal NEC diagnosis documented in medical records
- Required surgical intervention for NEC complications
- Suffered long-term health complications from NEC
- Died as a result of NEC complications
The Watson family’s case demonstrates that legal recourse is possible even years after the infant’s death or injury. Parents should consult with attorneys specializing in product liability or medical malpractice, as statutes of limitations vary by state.
How do formula companies defend against NEC lawsuits?
Mead Johnson, manufacturer of Enfamil Premature Infant Formula 24 Cal, disputes that its product caused Chance’s NEC. The company emphasized during opening statements that all neonatologists scheduled to testify still use formula in their NICUs because infants who don’t grow have lower survival rates.
In a statement to investigators, Mead Johnson stated: “Mead Johnson has over 120 years of expertise in infant nutrition and stands by our unwavering commitment to sound scientific innovations that provide safe, high-quality infant formula products to every parent and caregiver who trusts us. We are very sympathetic to Ms. Watson, but allegations from the plaintiff’s lawyers are without merit and attempt to grossly oversimplify complex medical conditions with attacks not upheld by experts in the medical community. We look forward to vigorously defending these allegations in court.”
The defense position acknowledges that formula doesn’t directly cause NEC but argues that breast milk protects premature infants from developing the condition better. Watson’s attorneys countered by promising to present research showing that while preemies given only human milk products grow slower than formula-fed counterparts, they don’t suffer long-term developmental effects.
A graphic highlighting baby formulas associated with NEC lawsuits, including legal contact information for affected families.
Why does donor milk access create healthcare disparities?
The trial revealed significant healthcare access disparities affecting NEC risk. According to a 2022 study in the National Library of Medicine that Patel co-authored, insurance coverage for donor milk – whether through private insurance mandates, Medicaid, or state budgets – exists in only 18 states.
“The majority of high-risk infants who need access to donor human milk are not born in a state or district where that access is guaranteed; no state currently covers the cost of donor human milk whether inpatient, outpatient or for all infants who may benefit from its use,” the study concluded. “State and federal level advocacy is needed to ensure that donor human milk is available to all infants based on medical necessity, rather than privileging infants who happen to be born in a state or district where access is guaranteed.”
Watson’s attorneys argued that financial incentives favor formula use, claiming that manufacturers often provide formula free to hospitals that agree to use it for 90% of their feedings. Meanwhile, human donor milk remains costly, creating a system where hospital location can determine a premature infant’s access to potentially life-saving nutrition.
What makes NEC so deadly for premature infants?
NEC’s rapid progression makes it particularly lethal. “One of the things that makes NEC tragic is it can happen suddenly and without warning,” Dr. Patel explained. “About one baby dies of NEC every day in the United States, so it’s really a very big concern. About one in every 10 deaths in the NICU are because of NEC.”
The disease causes intestinal inflammation that can quickly progress to tissue death. Treatment, if caught early, includes stopping all feeding and administering antibiotics. Severe cases require surgery to remove infected intestinal tissue. Chance Dean underwent three surgeries before his death, according to his attorneys.
“If they can survive the surgeries and surgery usually involves removing some of their intestines that have been infected, they can have a lot of long-term challenges,” Patel testified. “And those center around the disease affecting their neurodevelopment, so they can be at higher risk for things like cerebral palsy and developmental delays as they get older.”
While prematurity itself increases NEC risk, feeding choices play a crucial role. “We do know one of the best ways to prevent NEC is by providing breast milk and breastfeeding, or when that’s not possible, to give donated human milk, which has been shown as a very effective way to prevent the disease,” Patel said. However, he emphasized NEC’s complex nature: “NEC is a multifactorial disease, so there’s not one single cause. Breast milk is one of the most important ways to protect babies from NEC, but we do know that even babies who just get breast milk are at risk.”
FAQ
Q: What is necrotizing enterocolitis (NEC), and why is it dangerous for premature babies?
A: NEC is a potentially fatal intestinal disease characterized by sudden inflammation of the intestines that can progress to tissue death. It primarily affects premature infants and can develop without warning. The condition has a high mortality rate and accounts for approximately 10% of all deaths in NICUs.
Q: Why do minority mothers and infants face higher risks of NEC?
A: Minority mothers, particularly Black mothers, experience disproportionately higher rates of preterm birth, which is the primary risk factor for NEC. Studies show that even accounting for prematurity, minority infants have higher NEC rates. This racial disparity has narrowed somewhat over time but continues to persist, according to Dr. Ravi Patel’s research.
Q: What role does infant formula play in NEC development?
A: Multiple studies have found that premature infants fed cow’s milk-based formulas have significantly higher rates of NEC than those fed human breast milk or donor milk products. While formula manufacturers dispute direct causation, medical experts agree that human milk provides better protection against the disease.
Q: Why isn’t donor breast milk available in all hospitals?
A: Only 18 states provide insurance coverage for donor milk through private insurance, Medicaid, or state budgets. The high cost of donor milk and financial incentives from formula companies (who sometimes provide free formula if hospitals use it for 90% of feedings) create access disparities. Most high-risk infants are born in states without guaranteed donor milk access.
Q: What are the long-term effects for infants who survive NEC?
A: Survivors often face significant health challenges, including neurodevelopmental issues like cerebral palsy and developmental delays. Treatment frequently requires surgery to remove infected portions of the intestine, which can lead to long-term digestive problems and nutritional challenges.
Q: What is the status of legal action against formula companies regarding NEC?
A: Hundreds of parents across the United States have filed lawsuits against formula makers like Mead Johnson (Enfamil) and Abbott, alleging inadequate warnings about NEC risks in premature infants. Jasmine Watson’s case is the first where a mother whose baby died from NEC has taken a formula company to trial.
Q: How can NEC be prevented in premature infants?
A: The most effective prevention is feeding human breast milk or donor human milk rather than cow’s milk-based formula. If NEC symptoms develop, early intervention can improve outcomes, including stopping feedings and administering antibiotics. However, even with optimal care, some premature infants still develop NEC.
Citations
Byers, Christine (February 27, 2024). ‘It’s a quick killer’ | Neonatologist on racial disparities of disease in formula-fed preemies. KSDK/MSN. https://www.msn.com/en-us/public-safety-and-emergencies/health-and-safety-alerts/it-s-a-quick-killer-neonatologist-on-racial-disparities-of-disease-in-formula-fed-preemies/ar-BB1j6DES?ocid=BingNewsVerp
