Pamela, I agree this is very complex. Phyllis also emailed me privately
for more explanation.
European experience with higher volume feeds of unaltered ebm fits your
experience as well (better growth and good tolerance). In the US, many
NICUs are afraid of cardiac stress of extra volume on preterm infants,
but in Europe they are fed higher volumes as tolerated. Perhaps that's
because most US NICUs keep to a 3 to 4 hour feeding schedule, requiring
larger individual feed volumes?
Here's the abstract of the study I was talking about:
Effect of sucking characteristics on breast milk creamatocrit.
Paediatric and Perinatal Epidemiology. 16(4):355-360, October 2002.
Aksit, Sadik; Ozkayin, Nese; Caglayan, Suat
Abstract:
Summary: One of the problems in the care of healthy children is that
mothers often give infant formulae to their normally growing infants in
the first 4 months of life because they believe that they are unable to
satisfy them. However, the association of fat content in breast milk
with the sucking pattern of the infant is not clearly known. In order to
determine whether the fat concentration of human milk was associated
with sucking characteristics of the infants, 80 healthy 2-month-old
babies and their mothers were included in the study. Milk creamatocrit
was assessed at the beginning, at the first, fifth and 10th minutes and
at the end of breast feeding. The creamatocrit values increased as the
time elapsed from the beginning of breast feeding. There was an inverse
relationship between milk volume and creamatocrit at both the beginning
and the end of breast feeding (P < 0.05). The mean milk volume was
higher and the mean creamatocrit at the end of breast feeding was lower
in the infants whose 2-month weight gain was higher than the 75th
percentile (75P) compared with those whose 2-month weight gain was lower
than the 25th percentile (25P) (for milk volume 105 +/- 36 mL vs. 76 +/-
30 mL, respectively, P < 0.05; and for creamatocrit value 11.4 +/- 4.0
vs. 14.3 +/- 3.8, respectively, P < 0.05). Milk volume is the most
important factor affecting weight gain of exclusively breast-fed babies,
and fat concentration of human milk is not a primary determining factor
in individual differences in weight gain of the infants and appears to
be secondary to factors such as number of feeds per day, duration of
breast feeding and the volume of milk sucked.
---------------------------------------------------
I agree that in some dyads, oversupply is a problem. I too see many moms
in whom oversupply is misdiagnosed, either because baby had difficulty
with a normal flow or baby was underfed and unhappy. It all comes down
to a good assessment and history, doesn't it?
Catherine Watson Genna, BS, IBCLC NYC
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