Thanks to all for the feedback on the lactoengineering idea to increase
growth rate for a baby with Down syndrome.  Thanks to all 8 who responded.
It is wonderful to have access to some of the great minds in lactation.  It
also helps to have people to shoot holes in potential theories (Thanks Jan.)

Barbara Wilson-Clay writes:
The cardiac issue may not be totally ruled out (I've seen people fooled
before and miss heart defects which only got revealed when babies were so
obviously failing to thrive).  Also, sometimes if their tone is really low
they will have difficulty with swallowing, and feeds will be very laborious
with fatigue setting in before they can finish.  Sometimes the babies will
have some silent aspiration as they fatigue during a feed.  This will cause
them to shut down and limit their intake.  Or the Down Syndrome could be a
red herring and the baby may be self-limiting due to something more common
such as reflux.

Have you seen heart problems still come up after an EKG?  Baby has been
evaluated by a cardiologist but I am not familiar with how reliable these
tests are.  Baby is VERY low tone, hence long feedings with a Haberman and
inability to direct feed from the breast or a standard bottle.  I will look
for aspiration.  I did not even think of that.  Thanks.  I will also keep an
eye out for reflux.

Rachel Myr writes:
Heating breastmilk to reduce the water content could be literally playing
with fire.  Condensed cow's milk can cause life threatening electrolyte
imbalance in babies, as can formula that is too concentrated.

I had not considered that decreasing water may cause an electrolyte
imbalance.  (Please do not look too closely at the imprints my head makes as
it bangs against the computer screen. :) )

Several people wrote about special growth charts for DS babies.  Thanks.  I
will forward them to mom.

A couple people mentioned the need for attachment parenting and suggested
getting baby to breast more often.

Mom is very adept and active with attachment parenting.  Baby is unable to
milk the breast.  Bottle feeding is this baby's reality until his tone
improves to the point that he is physically able to milk the breast.  Right
now, putting baby to breast will be likely to decrease growth.  Mom is
offering the breast for comfort between feedings and baby is barely able to
manage to suckle the breast for comfort.

Last Jan writes:
I was unaware that there was a difference in amount of protein or
carbohydrate in the foremilk vs. the hind milk.  I was under the impression
that both protein and lactose were constant throughout the feed, though
would go down in percentage (but not amount) as the fat content increased
during the end of the feed.  But that doesn't mean there is any less protein
in the hind milk.

Jan, I had not suggested that fore milk and hind milk might have differing
amounts of protein and I knew that carbohydrate content does not change.
What I was suggested was if the cream was spun off, there should be more
protein in the skim than the cream portion.  Logic would dictate if there
was more cream in the fraction of milk there should be less protein per ml.
Well, of course when you wrote what you did, I started to look for
references to support the "logic."  I looked, and looked, and looked.  What
I did find was almost NO references to the protein content in the skim
fraction vs. the cream fraction until I came across an older text that I had
not read thoroughly yet called "The Lipids of Human Milk" by Robert G Jensen
c.1989.  On pp. 158-159 there are two tables that show the amount of lipid,
phospholipid, cholesterol and protein in the whole, skim & cream fractions
of milk.  The tables are referenced back to a study by Patton, S & Huston,
GE,  Membrane distribution in human milks throughout lactation as revealed
by phospholipids and cholesterol analyses, J Pediatr. Gastroenterol. Nutr.,
5, 602, 1986.  It turns out there is actually slightly more protein in the
cream fraction than the skim fraction.  Go figure!  (Again more imprints as
my head bangs against the computer screen.)

Thanks to all who responded.

Linda Pohl, IBCLC
Phoenix, AZ

             ***********************************************

To temporarily stop your subscription: set lactnet nomail
To start it again: set lactnet mail (or digest)
To unsubscribe: unsubscribe lactnet
All commands go to [log in to unmask]

The LACTNET mailing list is powered by L-Soft's renowned
LISTSERV(R) list management software together with L-Soft's LSMTP(TM)
mailer for lightning fast mail delivery. For more information, go to:
http://www.lsoft.com/LISTSERV-powered.html