This has been a very enlightening discussion, and I sincerely appreciate the
knowledge, professionalism, and passion from the likes of Valerie, Nancy,
Barbara and others. I accept that expressed milk, including hand expressed
and (probably more likely) pumped milk, could be contaminated. I accept that
premies, (especially micropremies) and other sick neonates, are at highest
risk from said contamination. I agree that getting babies to direct
breastfeeding would decrease these risks. What I want to know is this: what
about the kangaroo mother care model? I have read about and heard talks
about and seen videos of very small premies being kangaroo-ed. It seems they
are taking all feeds at breast or maybe some that are hand expressed and cup
fed. The key seems to be baby-wearing 24/7 with ad lib small feeds, in
continuous contact with mother. Wouldnt' this greatly decrease these
contamination risks? Remember I am very familiar with the USA NICU
environment and culture, having been a level 3 nicu nurse/head nurse for 11
years at a tertiary center (Ochsner, New Orleans) and of course I currently
work with nicu babies as an LC. Mother/baby separation is the norm. Mothers
and babies are together for only a few minutes for a few feedings each day,
even for basically well "feeders and growers."  I agree with Barbara that
premies are not competent feeders and often fatigue, etc and need comp
feeds, but...what if they were truly cared for in the KMC mode? What would
their immune status be? Would they be colonized differently etc?

Laurie Wheeler, IBCLC, MN, RN
New Orleans Louisiana, s.e. USA




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