Why indeed? Faster growth than what would be achieved by exclusive
breastfeeding or breastmilk feeding, is not necessarily better. It may be
that we just don't know how much faster is better, and at which point rapid
growth starts being a liability rather than an asset.
Alan Lucas is connected with research into infant growth rates, esp. among
babies born pre-term or SGA, so I did a quick PubMed search for recent
articles of which he is a co-author. Of about 40 hits, these were the most
relevant ones I found. All the abstracts are available on line but the
articles are restricted access. You can use the links to the abstracts.
Rate of growth is not the only issue with supplementation/fortification of
breastmilk to very low birth weight babies; quality of growth matters too.
As many before me have pointed out, these babies should still be getting
nutrients IV, through a placenta. How fast they should be growing is
anyone's guess, but they should not be growing more rapidly than their
bodies can manage to keep up with in terms of bone mineralization or
production of red blood cells, or liver enzymes, or immunoglobulins, for
example. They should be getting sufficient energy and protein to allow for
unhindered CNS growth and maturation. We don't know how much that is in
many cases, because we haven't had that many of these babies to practice on
before, and the only thing we can say with 100% certainty is that what we do
today based on best current knowledge, is not what we will be doing in
another 10 or 5 or maybe even 2 years, because our knowledge is in such a
state of flux in this area. The last word will not be spoken for a long
time.
If there are NICUs relying primarily on weight as a discharge criterion,
this may be a dangerously shortsighted view. Insulin resistance or poorer
cardiovascular health in adolescence seems a stiff price to pay for a
shortened stay.
It would be refreshing if there were as many funding sources available to
study lactoengineering for VLBW babies, as there are for supplements with
GMO fatty acids, minerals, proteins and whatever other concoction the
nutrition laboratories are serving up to 'supplement' or even compete with
Mom's old-fashioned home-made stuff.
There is research by Jane Hawdon suggesting that use of breastmilk
substitutes to keep blood sugar within normal ranges the first few days in
low birthweight babies, actually delays the baby's ability to regulate blood
sugar on its own, compared with using human milk, banked or expressed by
mother. It remains to be seen whether the short term effects of formula on
insulin response are related to altered insulin sensitivity in later life.
In this area there is so much still to be learned.
Rachel Myr
Kristiansand, Norway
Singhal A, Cole TJ, Fewtrell M, Deanfield J, Lucas A. Is slower early
growth beneficial for long-term cardiovascular health? Circulation. 2004
Mar 9;109(9):1108-13. Epub 2004 Mar 01.
(they found that it seemed to be better not to grow too fast the first few
weeks)
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Ab
stract&list_uids=14993136
Morley R, Fewtrell MS, Abbott RA, Stephenson T, MacFadyen U, Lucas A.
Neurodevelopment in children born small for gestational age: a randomized
trial of nutrient-enriched versus standard formula and comparison with a
reference breastfed group.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Ab
stract&list_uids=14993543
From the above abstract-
"CONCLUSIONS: The previously reported enhanced linear growth in SGA children
fed enriched formula was not matched by a neurodevelopmental advantage. At 9
months, girls fed the enriched formula had a significant developmental
disadvantage, although this was not seen at 18 months. Later follow-up will
determine any long-term effects on health or development. Meanwhile, use of
enriched formula for term SGA children should not be promoted. It seems that
breastfeeding may be especially beneficial for neurodevelopment in children
born SGA."
Singhal A, Fewtrell M, Cole TJ, Lucas A. Low nutrient intake and early
growth for later insulin resistance in adolescents born preterm.Lancet. 2003
Mar 29;361(9363):1089-97.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Ab
stract&list_uids=12672313
From the abstract-
"INTERPRETATION: Our results suggest that relative undernutrition early in
life in children born preterm may have beneficial effects on insulin
resistance."
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