12/13/95

Dear all LactNetters,

As promised, I'm writing to keep you apprised of the info I have gathered on
this subject.  I want to send a special acknowledgement of thanks to Dr. Tom
Hale at Texas Tech University School of Medicine and Dr. Katherine Dettwyler
of Texas A&M University.  Those two Texans answered promptly with helpful
information.  Another very special thank you goes to Dee Keith who has put me
in touch with an RN, IBCLC who has extensive experience working with babies
receiving bone marrow transplants and who has been successful in establishing
protocols that have allowed some of these infants to continue receiving
breastmilk during the transplant procedures.  As this info comes in I will
bring you up-to-date on what I learn.

Dr. Hale pointed out 2 possible areas of concern that must be addressed and
these are the fact that breastmilk is not a sterile fluid and that
breastfeeding could provide a source of infection to an infant that is
immunocompromised.  This is the reason why the infant will be fed only
sterile fluids.

Several of you have written to me and asked why couldn't the baby receive
sterilized expressed breastmilk.  A good question!  And, just the one that I
hope to get some answers for soon.

The other concern Dr. Hale pointed out was the possibility of Graph vs Host
disease by the introduction of dissimilar (maternal) set of cells to the
infant via breastmilk following the transplantation.  Concern for this
rejection response probably underlies the doctors advice to this mother to DC
breastfeeding.  Again, I hope to have more answers on this issue soon.

Dr. Dettwyler's post was particularly helpful in providing information that
will help me encourage this mother to maintain her milk supply even though
she may not be allowed to give her baby her breastmilk during the
transplantation procedure.  She pointed out the immunological benefits and
indicated that all studies to date (even though these studies stop at 2 years
post-partum and therefore, fail to follow the health consequences of
breastfeeding beyond 2 years pp) indicate that the longer the child is
breastfed, the better the infant's health, with children breastfeeding 18-24
months doing better than those breastfeeding 12-18 months and those better
than infants breastfed only 6-12 months.

I will keep you posted as I learn more about protocols that may allow this
infant to receive his mother's expressed breastmilk during the
immuno-suppression phase of the transplantation procedure and for the period
of time after the transplant during which the infant will be monitored for
rejection of the transplant.

Diane, thanks for the kind words about my Syracuse presentation.

Dee, great fun talking with you last night.  LLLoved sharing. (;-)

Anna R. Utter, BS, IBCLC
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