Ann, thank you for sharing the study, "Effects of Human Milk Fortification on
Morbidity Factors in Very Low Birth Weight Infants."  I am troubled by yet
another study making comparisons of feeding groups when those feeding groups
are not exclusive to one method or another.  "All infants were fed their own
mother's milk and in case of insufficient breast milk, formula feeds were
used to meet the total energy requirements on that particular day."  In the
JHL of June 1991, Auerbach et al. states,

     "It is clear from our brief review that the literature comparing infant
feeding groups and their relationship to specific neonatal conditions,
maternal patterns of choice, and more general issues or [of] morbidity and
mortality is in disarray, primarily as a result of the lack of consistent
differentiation of feeding groups.  As a result, nearly all findings deriving
from such studies merit vigorous challenge."

Clearly, this statement is as relevant today as it was 11 years ago. How sad
that we seem to have gained little ground in regard to research of infant
feeding.  We still are making no real comparisons and making health care
policies based on poor evidence.

These researchers used a Wyeth milk nutrient composition chart to present the
differences between preterm milk and fortifed human milk.  It is ironic that
infant formula companies have such ease of access to breastmilk samples.  And
it is rather
curious that we, breastfeeding advocates, accept readily their assessment of
breastmilk samples.

This study states that "there is a significant reduction in the duration of
hospitalization because of faster growth rate in babies receiving
fortification, with economic and psychological benefits for the parents. The
shorter duration of hospitalization may decrease exposure of these babies to
nosocomial sepsis and thus contribute to the overall reduction of sepsis and
the associated morbidity in VLBW babies."  Isn't this a catch-22?  Is fast
weight gain an indicator of good health outcomes?  Fortifier's because of the
higher fat and protein content would in all liklihood put weight on an
infant, allowing the infant to go home earlier. Wouldn't that fact be
relevant to making comparisons of morbidity with these babies?  The fatter
babies go home quickly lowering their risk of nosocomial infections.  So is
the risk exclusive breastfeeding or is the risk the fact that the exclusively
breastfed infant may not gain "fast enough" and therefore is more heavily
exposed to hospital infections?

It is worth noting that in this study there were more infants in the control
group (not fortified) who were younger in gestional age and weight.  It was
not many and the study considered it statistically insignificant.  Yet, each
group was only 50 infants and when you have 2-3 infants on the lower end of
the spectrum in one group I would suggest that it has a relative impact on
the findings.  Of course if this was a study of 1000 infants, then 2-3
infants on the lower end would not be as significant.

This study makes no mention of funding sources.  I think it would be
important thing to know.  They used Wyeth charts, one might assume that
possibly Wyeth donated something.  But we really don't know because no
statements are made.

Valerie W. McClain, IBCLC


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