Dear Ladies,

Permission to post... I would appreciate any information on the following case.

Term baby boy born with several fetal asphyxia (pH 6.8), currently on a ventilator and stabilizing, yet unclear of neurological status.  However, his liver, kidneys, and bowel are beginning to recover.  TPN was initiated at approximately 24 hours and half-strength Pregestamil at 48 hours.  Mom has been pumping and providing breastmilk for baby and has questioned the use of Pregestamil rather than her breastmilk.

The neonatalogist (extremely supportive of breastfeeding in my experience) has explained to her that she is only using Pregestamil to "test" the bowel (absorption rate), then will switch to her breastmilk.  As I understand it, 5 cc of Presgestamil was given with initial feed via NG, and at three hours his absorption rate was assessed and a residual of 3.5cc was found.  This was explained to be appropriate (successful), while the residual was readministered.  Another three hours passed and the residual was found to be 1.5 cc (too high now) and was discarded.  The physician was notified for further orders and mom has not followed up with me concerning the doctor's recommendations at this point.

We discussed questioning the physician on why this "bowel test" could not be completed with her breastmilk (colonization, risk of NEC, aspiration) and through her communicating through the nurse to the physician, mom was told that this was not a "formula" but was a "test" and after he received this every three hours over the next week, she would immediately order breastmilk feedings.  The neonatologist encouraged mom to pump and save every drop and that it would make a difference, yet I am not able to rationalize for this mom why this particular formula would be preferred over her breastmilk in light of his incredible risks for both NEC and aspiration.

I understand because of his asphyxia, he will likely have a decreased amount of bile in his intestine, subsequently leading to a profound defect in fat digestion and absorption, which could lead to an essential fatty acid deficiency leading to decreased bone mineralization and failure to thrive...and that Progestamil is therefore used to maximize fat intake, as 11% of its calories are derived from linoleic acid.  I also understand that it is thought that breastmilk might be detrimental to these infants because of its high fat content.  I am still not convinced this is the best option and would greatly appreciate any input, while I continue to search.


Penny Lane RN, BA, IBCLC
Maternal & Child Health: Lactation Consulting
Believe - Birth & Breastfeeding Resources
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