Valerie wrote: <<No infants in the control group died.  But 6 infants died in
the group of 43 infants fed mostly human milk?  Six infants also died in the
group of 120
infants that got the (fish/fungal) DHA. >>

No!! Look again!

<<During the course of the study, 6, 3, 6 and 0 infants in the control,
AA+DHA (fish/fungal), AA+DHA (egg-DTG/fish) and EHM groups died.>>

According to this sentence, *no* infants died in the group of 43 babies
called "EHM" (exclusively human milk fed during early neonatal period). The
problem is that, at this point in the report, the writer changed the order of
reporting the groups, which makes it VERY confusing. (Let's trust that it was
not done DELIBERATELY to mislead the casual reader into thinking 6/43 EHM
babies died! That would be about a 14% mortality rate for the EHM babies.)

2% of those 43 "EHM" babies dropped out of the study (i.e., just one baby)
because of feeding intolerance, and as Valerie points out, these EHM babies
probably all got non-human milk in the form of fortifier. So, NO babies were
truly *exclusively human milk fed.*

I'm not sure whether there is a NICU anywhere that really provides exclusive
human milk feeding for babies with this degree of prematurity (under 33 weeks
gestational age and with birth weights fo 750-1805 grams)...possibly in
Scandinavia? London UK and Santiago Chile were the only non-US sites in the
study. Human milk fortifier is standard in US NICUs. (And if it were actually
made from human milk as the name ---misleadingly---implies, I wouldn't see a
problem with using it.)

I wonder how the researchers decided who would be in the "control" group and
who would be in the "EHM" group. Doing the math (43 EHM + 144 control + 140
fish/fungal + 143 fish/egg = the 470 enrolled) shows us that the EHM group
was a separate group of babies from the start. I would like to know how these
babies were differentiated from the control group at the outset of the study.

I am disappointed that the write-up does not report what happened to the EHM
babies after they reached "term CA"--which I assume is "term corrected age,"
meaning their due date. I hope the study did follow these babies to 12 months
CA. After all, they were the group with the potential of receiving the
"closest to biologically normal" feeding. Anybody tinkering with the recipe
for formula would want to know how it measured up against babies who got
human milk and not formula...wouldn't they...? [tongue in cheek]

About 1/3 of the babies in the three non-EHM groups were getting human milk
at least once a day when they reached term CA, and about 1/8 were still
getting some human milk at four months. So gee whizz...here's another study
where what was really being compared was groups of babies on mixed feeds.

It sure does cloud the issue when babies in the "EHM" group get non-human
supplements in the form of fortifier, and babies in the three formula groups
get human milk!

Chris Mulford, RN, IBCLC
working for WIC in New Jersey
Co-coordinator, WABA Women & Work Task Force




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