Hi Amy,
Anything by Paula Meier would address the issue if you have time to do a lit
search.  Also, the following is an excerpt of a paper I wrote on this very
topic.  Please note that this paper was NOT written for lactnet and so eases
the reader into an understanding of why artificial milk should not be used.
Hope it helps.
Joanne


Breastmilk

Breast milk has unique properties making it the optimal form of nutrition
for all infants, but vitally important especially for early and small
infants. Preterm breastmilk contains the necessary higher amounts of
protein, calcium, and fat and adjusts to meet the changing needs of the
maturing neonate.

The elements in breastmilk interact with each other and adjust chemically
over time, as it is a living fluid.   During pregnancy, the cells in the
milk producing glands are moving closer together, the final step being the
transition from colostrum to mature milk.  In a mother who has delivered a
baby prematurely, this process is still occuring, continuing during
lactogenisis and beyond, producing milk that has the exact composition
appropriate for the gestational age of her baby.  Thus, preterm breastmilk
has similar composition to colostrum, and contains "long chained
polyunsaturated fatty acids which help neurological development" and
"improve brainstem maturation for preterm infants." (Newman, 2000, p. 312)
(Francis, 1999, p. 1)

Breastmilk contains docosahexaenoic acid (DHA) which, although it can be
artificially added to artificial formula, must be absorbed to be of any
value, (and this is problematic in artificial milk) and must be in correct
proportions with other elements in the milk, which if not correct, can be
toxic.  (Newman, 2000, p. 312)  Similarly, the iron in artificial milk is
mostly (90%) excreted by the baby where as most (more than 50%) of the iron
in breastmilk is absorbed because it contains lactoferrin which is partially
responsible for the high percentage of absorption.  (Newman, 2000, p. 313)
Breastmilk contains growth factors, antibodies and immunities that bolster
and buffer the neonate's immature immune system, minimizing incidences of
infection and readmission to the NICU by 7 to 1.  (Meier, 1996, p. 352)
Hylander et al. (1998, pe38) found that "the incidence of any infection or
sepsis/meningiticare was significantly reduced in human-milk fed VLBW
infants compared with exclusively formula fed infants." Breastmilk contains
neuro-trophic, anti-inflammatory and epidermal growth factors.  (Newman,
2000, pp. 311-312)  Breastmilk digests easily and completely, minimizing
gastro-intestinal upset, vomiting and the babies could tolerate feedings
significantly better.  (Meier, 1996, p. 353)  Breastmilk also prevents
exposure of the immature GI track to exposure to the ingredients of
artificial formula that cause illness, inflammation, allergy and potentially
fatal diarrhea. (Meier, 1996, p. 352)   Newman (2000, p. 306) includes
necrotizing enterocolotis as an unnecessary and avoidable iatrogenic
complication of artificial formula. NE has been shown to be 20 times higher
in artificially fed neonates.  (Meier, 1996, p. 352) Newman (2000, p. 306)
also considers that premature retinopathy can be increasingly minimized when
neonates are given human milk. Improved retinal function for neonates on
breastmilk can be attributed to the levels of Omega-3 fatty acids found in
breastmilk.  (Meier, 1996, p. 353)  In May of 1991 Pediatrics (www.aap.org)
gave a mathematical algorithm for infant mortality, calculating 4 out of
every 1000 infants die as a direct result of ingesting artificial formula.
Thus, breastmilk is not just superior to artificial formula, but it should
be considered the standard, rendering formula as an inferior and dangerous
substitute, one to be actively avoided whenever possible.

Fortifying human milk is often suggested to increase the caloric intake for
the baby.  Lacto-engineering of human milk can increase caloric intake by
expressing human milk and then separating out the foremilk (the first 30 ml)
from the hindmilk, which is much richer in fat, (every gram of fat yields
nine calories) and nutrients.  (Newman, 2000, p. 316) Other forms of
lacto-engineering include further individualizing the lipid content of the
mother's milk.  (Meier, 1998)  It is also commonly assumed that babies born
early should have the same rate of growth as babies born at term, however,
"there is no evidence that a baby who grows at intrauterine growth rates is
better off when he is 5 or 20 years old.and if faster rates of growth just
results in more fat cells being laid down, as has been postulated, the
intrauterine growth rate may actually be less desirable."  (Newman, 2000, p.
310)  Schanler (1999, p. 1150) concluded, "the benefits of improved health
(less sepsis and necrotizing enterocolitis) . out weigh the slower rate of
growth."

 Lastly, since the incidence of prematurity is high among adolescent, poor
and uneducated mothers, breastmilk provides a cost effective and readily and
perpetually available source of optimal nutrition.  Breastfeeding has been
referred to as the "safety net against the worst effects of poverty.and
takes the infant out of the injustice of the world of poverty into which it
was born [at least] for those first few months of life."  (Grant, in
Lasxarov, 2000, p. 15)
Milk transfer

Similarly, the milk delivery system impacts the infant's neuro-physiology.
Breastfeeding has been shown to be less stressful than either cup feeding or
bottle-feeding as assessed by heart rates, oxygen levels and respiratory
rates. (Howard, 1999, p. 1204) While feeding at the breast took longer, the
babies maintained higher oxygen levels, better heart and respiratory rates.
Methods that can ensure that babies receive the quality and quality of
breastmilk without compromising feeding at the breast, caloric expenditure
or the stability of the neurophysiology can include concurrent supplemental
nursing systems or gavage feeding.  These methods give the baby the feeling
of satiety while at the breast, encourage exclusive sucking at the breast wi
thout the risk of nipple confusion, deliver human milk or lacto-engineered
human milk without compromising caloric intake versus expenditure while
enjoying the physiologic and sensory benefits of the social contact and
co-regulation with mother. For the mother, the benefits of breastfeeding (as
well as the myriad of personal health benefits) even with the SNS or gavage
is that it includes the benefits of skin to skin holding, increases her
sense of competence in handling and putting the baby to breast, removes
barriers to physical and psychological contact and very importantly,
increases milk supply.  Mothers have been shown to be able to pump
significantly larger quantities of milk after Kangaroo care and putting the
baby to the breast in the NICU.   (Furman, 1995, p. 26)  This is likely due
to the physical proximity that triggers the production of oxcytocin, which
is even possible just sitting near an infant who cannot yet be held.
(Gotsch, 1999, p. 31) Especially effective is a technique called cluster
pumping where a mother pumps for 20 minutes, rests for a few minutes and
then pumps again which simulates the way a baby naturally nurses. Pumping
provides milk for lacto-engineering, SNS or gavage feeding when the mother
is not present, and psychologically important evidence of her physical
capacity to physically provide for this baby (Stern, 1995, p. 173)

----- Original Message -----
From: "Amy Smith" <[log in to unmask]>
Sent: Wednesday, January 02, 2002 6:37 PM
Subject: BF premature infants facts needed


I am putting together a proposal (very short, in fact just a letter) for
funding and need some quick facts!

Can anyone provide me with some basic facts on the benefits of breastfeeding
with premature infants?

I know that I have stuff around here in the office but the letter is due
ASAP and thought that the wealth of LactNet Knowledge would surpass my
diligent digging.

Thanks!
Amy Smith
Healthy Mothers, Healthy Babies of Kern County
Bakersfield, CA
[log in to unmask]

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