Dear All,
   
  I'd like to comment on the baby recovering from burns.  Nutrition from burn recovery is especially demanding on protein/amino acid levels. I found that protein requirements were estimated at 2-3 times normal levels.  Research shows increased infection, morbidity and mortality directly correlated to low nutrients during recovery, especially protein.
   
  I'm not home now, so can't find protein levels in breastmlk. I suspect that it would be hard to get breastmilk up that high.  I have never used Paula Meier's technique personally for an ill baby, but reading the info indicates that the lipid levels are being concentrated to increase energy.  Amino acids and proteins vary in the water and fat soluble properties so some will be removed with the foremilk --thus actually decrease that fraction of the milk compared to the increased fat.  Some specific amino acids are mentioned in relation to burn recovery (glutamine, arginine, and sulfer amino acids like cysteine) http://www.burnresearchcenter.org/brcpublicwebsite/projects-aminoacid.htm Those three are perfect example of mixed solubility --some like cyteine are very water and some less water soluble (more fat soluble).
   
  I don't know enough about burn recovery to also judge whether concentrating the milk, thus decreasing the fluid content is a good or bad idea for a burn patient because of their increased water loss through the damaged skin.  I would guess the IV will make up the hydration requirements, but it is something to think about.
   
  In regard to putting breastmilk on the burns, if the baby is on any type of antibiotic, I wonder if breastmilk would increase risk of fungal growth just as Candida (thrush) grows on a breast/nipple when the tissue is damaged or the mother has been on antibiotics?  What do you all think?
   
  I agree that this baby is very fortunate to be breastfeeding and think the skin recovery will be optimal (just like a cleft repair) due to the active use of the muscles thus increasing perfusion and lymphatic flow.   
   
  (and of course the optimimum immune function and comfort--decreasing stress are understood and without match!)  My best thoughts to this family for a quick and uneventful recovery.
   
  Karen Seroussi, LLLL, IBCLC, MS-2
  Des Moines, IA

       
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