Denise's post on looking at what the rest of the world is doing for their premies brings me to share a knowing that I learned a long time ago. It was back in the early '70s when doctors were requiring mothers to have their milk tested to see if it had adequate nutrition. One mother's milk would be too low in fat, the next had too much fat. One mother's calcium levels were too high and the next mother's ca levels were too low. Many mothers were told to wean based on those tests because levels of any nutrients that they tested varied greatly from one mother to the next. Then "someone" [I can't find the research or who the researcher was.] followed a group of babies for 6 months and the mothers' milk was tested along with their babies' growth and development. It was discovered that the milk changed often to accommodate the baby's nutritional needs. Of course, we all know now that the fat varies with the fullness of the breast when the milk is collected. But differences are present for other nutrients as well as the baby grows. The conclusion was that it is baby's *saliva* that sends a message of his nutritional needs through the nipple (which we know is a two-way conduit) with each feeding and the milk is programmed to that need. It is similar to the way that baby's saliva stimulates antibodies from the mother when baby has been exposed to infection. In Kangaroo Mother Care the tiny premies are at the breast and the milk of their mothers is very different from what it would be if the mothers were just pumping. The pumped milk that has not been "programmed" by the baby's suckling may not be adequate in some of the nutrients that are being tested for and, thus, in some hospital settings the missing nutrients are added with fortifiers. It is not a lack in breastmilk but a lack of opportunity for baby to stimulate her needed nutrients in the proper concentrations unique to her in her mother's milk. If a tiny premie is not able (or not allowed) to suckle at the breast her mother can get saliva from baby's mouth and rub it onto her nipples. That helps in the programing. I had a client whose baby had a bruised tongue after the birth and he couldn't feed at the breast or with a bottle. Mom had a good supply and fed the baby with a spoon. Her milk was milk-white. When baby healed and began suckling at the breast sometimes (about 2 weeks) she called me in alarm. "My milk is dark yellow!) The volume was bountiful still but baby had said, "I didn't get my colostrum," and his saliva stimulated the breasts to add colostrum for about 3 days. Then the milk returned to white. I have seen this repeated many times with mothers who are pumping and whose babies did not feed adequately at the breast before the mature milk came in. I have come to expect it. You know the look of the early transitional milk. I had a client last month whose baby was using a nipple shield since day 2. He was thriving because of a bountiful milk supply. The milk was white. The mother called me because she wanted to have the baby at the breast. We tried a couple of times one day and decided to let a little more time pass. Later in the day the mother noticed that the milk in the shield was very yellow. I encouraged her, as I always do, to invite her baby to the breasts several times each day. Again the milk remained yellow for a few days then returned to white. Well, this is my take on the fortifying issue. Sometime someone will replicate that study and we will then know how the premies in Pamela's hospital and other places around the world are adequately fed with their mothers' milk and the premies in "my" hospital are not. Perhaps Peter Hartman or one of his associates will take on this study anew. I don't know where the funding will come from because the outcome will not be of monetary benefit to anyone, but I'm hoping that someone will be interested enough to pursue it. So... we still don't know everything, do we? Pat Gima, IBCLC Milwaukee, Wisconsin Mailto:[log in to unmask] *********************************************** 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