Debbie Ravin's post about the NICU baby who tolerated Progestamil and
not mother's milk put me in mind of the fact that I see baby's pulled
off mother's milk because they "don't tolerate it".  It has occured to
me that some of this may be due to how we feed/handle the expressed
milk.  I recently read something by Paula Meier that stresses the
importance of giving fresh (as in preferably not even refrigerated but
straight from "the source" and preferably not frozen) to preemies that
are being gavage fed whenever possible.  She says that there are a few
exceptions to this rule.  If a preemie isn't fed until several days
after birth, the mother's frozen colostrum should be the very first
feed, before any fresh breastmilk is given.  Studies have shown that the
colostrum has amazing immune boosting and gastrointestinal trophic
effects and should be the first enteral feed. I don't know that this is
the practice in our NICU.  I intend to find out.  And my question is,
can this play a role in future feeding tolerance?
(Groer M, Walker WA:What is the role of preterm breast milk
supplementation in the host defenses of preterm infants?Science vs
fiction. Adv Pediatr 1996;43:335-358.
Mathur NB,Dwarkadas AM,Sharma VK, et al:Anti-infective factors in
preterm human colostrum. Acta Pediatr Scand 1990;79:1039-1044.)
Edie Armstrong BSN, IBCLC, Fairfax, Va.