Fragile infants usually cannot directly breastfeed  in a way that assures
all their nutritional needs.  If they can breastfeed at all, they tend to be
weak feeders who fatigue easily and require complementary and supplemental
feeds.  Some of them have mothers whose physical condition precludes direct
breastfeeding or even the ability to make enough of their own milk to
deliver to their own infants.  Some, as in the case of CMV positive moms who
deliver prematures, cannot safely provide fresh human milk to their infants
because these infants lack sufficient transplacentally acquired immunities
against CMV. Freezing (and pasteurization) deactivate CMV, but this is only
one of many considerations when managing the fragile infant.  I am aware of
case reports where breastfeeding infants have died or been significantly
damaged by early acquired  herpes infections when the mother was not aware
that she had recently acquired the disease.   There are so many issues
involved with the alternate feeding of these babies. Does this mean formula
is better?  NO. Can we prevent every accident?  Of course not.  In clinical
management one always must balance risks and benefits with the individual's
present situation. Would I like more medical professionals, esp.
neonatologists to be stronger advocates and better informed about human
milk?  Of course.  Do I think we ought to be more politically sensitive to
the ones who are our allies.  You bet I do.

Finally, one reason we all worked so hard (as volunteers) to found a milk
bank in Austin was to have safe alternative ways to eliminate or reduces the
need for artificial formula when mother's own milk presents a temporary risk
to her infant or when her own milk is not available.

Barbara Wilson-Clay, BS, IBCLC
Austin Lactation Associates
LactNews Press
www.lactnews.com

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