I would like to ask for help with a couple I have been helping via
email.  I have already located a local IBCLC for them to get in
person support but they could also use some expert opinion from
lactation experts who have experience with preemies with BPD.

History:
First baby. Chronic abruption during pregnancy with hospitalized
bedrest followed by PROM and c/s delivery at 25 1/5 weeks on Sept
10/98 weighing 840 grams (1 lb, 13 oz.)  Baby is currently 8 weeks
old and weighed 3 lbs at 6 weeks.

Baby began milk feeds one week after birth and is on continuous
gavage feeds.  Mum has had trouble bringing a milk supply but
continues to pump and has begun herbs. Mum is currently only getting
a few mls at a session which the doctors will give to the baby. She
has had a prolactin level done and I suggested a thyroid level as
well but no results as yet. This is an issue that the local LC and
hospital LC will continue to work on with mum.

The SIL is nursing a 5 month old and donated breastmilk which was
given to the baby girl for three weeks.  At one month of age, the
opinions on the donated EBM changed and then the attending
physicians changed as well. The baby was diagnosed with advanced
Bronchiopulmonary Dysplasia.  The donated breastmilk was stopped and
the baby was put on 27 calorie formula.  The family was told that
the SIL's milk was inappropriate - rickets, fat content etcetera.
When the family asked if it could be fortified.  The staff shifted
their story to stay that they had no policy for giving donated milk
and thus couldn't do it. With each change of attendings the reasons
for not giving the donated EBM change. The latest being a concern
about infection. Baby has had some staph aureus infections - eye
discharge and lung colonization - which have been treated with
antibiotics.

The baby is currently on 100% oxygen and the family is very
concerned about her health.  They agree with the doctors that growth
is an important issue as this might help her to outgrow some of the
BPD.  They are also concerned about infection.  The parents feel
that breastmilk from the SIL would be helpful but feel that they
need some ammunition from other experts who have experience with BPD
and giving donated breastmilk.

The parents state:

> Is there a way for Julie and I to determine whether there are
>   any NICUs anywhere that treat babies with severe
>   BPD with fortified breast milk (that doesn't come
>   from mom)?
>
>    It is a little hard for us right now to reject the
>    policies of the NICU since our daughter is in such a
>    fragile state. Her current ventilator settings are very
>    high (near 100%) and all the "professional"
>    literature I've read (including abstracts that Janet
>    has sent us)states that precise nutrition is critical to
>    reducing mortality in BPD babies in the NICU and
>    after they come home.
>
>    I don't think we can challenge the NICU policies
>    unless we can talk to and/or see research of other
>    clinicians who have direct experience with BPD
>    babies and "secondary" breast milk.
>
I have done a Medline search but most of the articles I could find
would more likely be interpreted to support the use of the ABM.

I have emailed Dr. Wight privately for her opinion. If she would
like to post to the list that would be wonderful too.

I have also given the family Paula Meier's/ Rush Mother's Milk Club
address to obtain their materials about skimming hindmilk and
lactoengineering.

Does anyone have any experience or references to share?

--
Janet Vandenberg, RN, BScN, IBCLC
Newmarket, Ontario, Canada
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