In a message dated 8/31/2005 7:30:30 AM Pacific Standard Time,
[log in to unmask] writes:
Nancy Wight wrote wrote that it is protein not calories that are most needed
by the premie. How do we know that? Does the mother's milk compensate in any
way by producing nutrients that are specific to the premie's need? Have any
studies looked at the compostition of premie's mother's milk?
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A quick look at Riordan, LLLI Answer Book or Lawrence will give you a few
references (there are >50) on the composition of premie milk. It has been
well-studied for over 25 years. Briefly, preterm milk has more protein, calories,
fat and sodium, but changes over 2-3 weeks to more mature milk. Unfortunately
the needs of the VLBW infant do not change that fast.
We think the reason that the milk is different if you deliver prematurely is
that the breast has not had the full pregnancy to develop and there are
greater gaps (leaky junctions) between the lactocytes allowing both good and bad
substances/bacteria, etc to pass.
Protein Content of Human Milk vs term and Preterm Formula Schanler & Oh. J
Pediatr 1980;96:679
Shows progression of protein in milk over time.
Higher Protein Intake Improves Growth in VLBW Infants Fed Fortified
Breastmilk Carlson Abstr 1638, SPR 5/1/00
Is a RCT of supplementing with increased protein vs increased calories.
Babies with increased protein did better.
For a good overall discussion of nutrition for preterm infants read:
Schanler RJ. The use of human milk for premature infants. In Schanler RJ
(ed). Breastfeeding 2001: Pediatr Clin North Am 2001; 48: 207-220.
OR
Schanler RJ. (2003). Chapt 28: The Low Birth Weight Infant, in Walker WA,
Watkins JB, Duggan C, eds. Nutrition in Pediatrics: Basic Science and Clinical
Applications, 3rd Ed., BC Decker Inc, Hamilton, Ontario, pgs 491-514
Nancy
Nancy E. Wight MD, IBCLC, FABM, FAAP
Neonatologist, Sharp Mary Birch Hospital for Women and Children's Hospital
Medical Director, Sharp HealthCare Lactation Services
San Diego, CA
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