I have often wondered a few things about preterm infants:

1. Are their caloric needs artificially elevated, at least in part, due to
how we care for them in most NICUs? The results of kangaroo care would
suggest that this could be the case.
2. Does kangaroo care speed the development of breastfeeding ability in
premature infants?
3. Since traditional societies practice "continuous" breastfeeding (small
feedings several times an hour), what would happen to the growth of preterm
infants if they were breastfed in the same manner once they were able to
breastfeed?
4. Since the biologically normal and most common means of attaining
sufficient levels of vitamin D for human beings (and the vast majority of
other free-living mammals) is direct exposure of the skin to sunlight, and
premature infants are born with abnormally low vitamin D stores simply
because they were born early, what would happen to premature infants'
"extra" needs for calcium and vitamin D through fortifiers if they had
short, intermittent direct skin exposure to natural or artificial UVB
radiation? The skin has an enormous capacity to make vitamin D. Whole body
exposure of an adult to one minimal erythemal dose (the dose that will just
barely cause sunburn) of simulated solar ultraviolet radiation is
comparable with taking an oral dose of 10,000 to 25,000 IU of vitamin D
(Holick 1995). Humans do not have to get even close to sunburned to produce
sufficient vitamin D. And the metabolic pathway of vitamin D production
inherently protects us from toxicity when vitamin D is
photosynthesized--something we cannot say about oral ingestion of vitamin
D.

I hazard to guess that there is much that we could do to enhance the
survival of premature infants in ways that are different than what we are
doing now--and with fewer risks and better outcomes. A spirit of inquiry
will help us identify which methods are good as they are, which need
adjusting, and which need to be replaced by something entirely different.
Like in every other area of life, we do the best we can with what we know.
And as our knowledge improves, we'll have the opportunity to do better.

Cynthia

Cynthia Good Mojab
Ammawell
Email: [log in to unmask]; Web site: http://home.attbi.com/~ammawell

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