Valerie,
I would just like to add a couple of points of clarification to your
response.  Of course I accept forumulas are not perfect and in all cases
(expect in the very rare medically not indicated eg galactaesemia) encourage
and support breast feeding.
>Formulas/HMFs are always "in the process" of improvement.  What that >means
>isthat last year's formulas/HMFs had problems but maybe next >year's
>formulas/HMFs won't have those problems.  Thus, the infant who >received
>formula or HMF last year was not receiving an optimal product >but a
>substandard product.  The infant formula companies learn to >improve their
>products by previous mistakes.   The sad thing for the >consumer is when
>the mistake happens to your infant.

The reality is however, not all parents choose to breastfeed, no matter how
pro-active we are in giving factual information regards its benefits and
encouraging the mothers.  Not all mothers with babies in NICU/SCN are able
to express sufficent amounts (and not all countries have access to banked
EBM) so that we who work in these units are left with no choice sometimes,
but to use formula.  I, for one, am very glad the standard of formulas has
continued to improve and that we have specially formulated pre-term formulas
that more closely meet there needs than the more primitive term formulas we
used to use 20 years ago.  They were HORRID and feeding intolerance was a
huge issue.  These preterm formulas are still far inferior to EBM but
certainly have resulted in improved growth rates and less feed intolerance
than the older formulas.  It is extremely sad when mistakes are made but to
put it in perspective, those mistakes are extremely rare and outcomes for
premature babies are continuing to improve.

>Marian writes, "The bottom line is that doctors and neonatolgists in >SCNs
>and NICUs prescribe HMF because they believe the benefits >outweigh the
>risks and that they have research data to back up their >decisions."
>Yet, one must pause and wonder about this research particularly when
> >portions of it are funded by the very industry that will profit from
> >this research Dr. Richard Schanler from Baylor College of Medicine who
> >helped develop human milk fortifiers received funding from Bristol
> >Myers/Mead Johnson,  and Ross (speakers bureau).  see conflict of
> >interest http://www.utdol.com/application/help/conflict.asp
>Lucas, whose name is  often brought up in regard to preterms needing
>fortification has a patent with Farleys.  Thus, the research that >backs
>upthe need for fortification of preterm infants is often >research backed
>by theinfant formula industry. I find that information >troubling and cause
>for concern about how much influence this industry >has on the feeding of
>premies.
Declaring where they received funding from does not necessarily equate to
taited research.  These researchers have published in reputable journals
such as "Pediatrics" which is the magazine of the AAP and has stringent
guidelines for accepting to print research articles.  Lucas, for example, is
certainly a highly respected researcher whose work in regard to beneficial
effects of breast milk on eg increasing IQ and prevention of necrotising
enterocolits has contributed enormously to our knowledge of the benefits of
breastfeeding.  A very large body of research into HMF has no declared
conflict of interest.
Back in April, when I first responded to a thread on HMF I responded to a
post by Nancy Wight
>I agree that "we know not what we do" when using fortifiers, but I >have
>seen too many premies in tha past with rickets and FTT to go >with with
>human milk alone for the VLBW infant.
>Nancy
HMF is currently being used in centres across the world, and it will
continue to be used--surely it is in everyones best interests to improve and
refine it.  Nobody has all the right answers for optimal infant feeding in
the pre-term population.  HMF does not just contain extra protein but
vitamin and mineral supplementation as well. This mineral supplementation is
necessary for prevention of rickets and improved linear growth.  If it was
my very low birth weight infant I would certainly want my EBM supplemented
with HMF.

>When I read the various patents that are imitating human milk >components,
>I find it hard to accept the research that denies infants >full use of
>human milk.  This denial of full use of human milk carries >a heavy price
>because women began to doubt the worth of the milk they >provide
Valerie, I think we may have to agree to disagree.  From my experience
parents readily accept the intervention of using HMF.  They see it as a
short term beneficial, intervention until they are fully breastfeeding. They
are supported, encouraged and congratulated on the EBM they express and
understand the HMF is an interventention to enhance their infant's growth
and nutrition. They are given information on the enormous benefits of EBM.
Parents are used to a myriad of interventions eg ventilation, IVs,
antibiotics and other medication, oxygen therapy etc. etc.  We are not
dealing with normal, healthy term baby babies, but babies who, in many cases
until 3 or 4 decades ago. often would not have even survived without
intervention.

Any Lactnetters who are interested in further reading so you can make up
your own minds may be interested in the following references.  I think it is
very useful if you may be dealing with parents of premature infants to more
fully understand the rationalle and research behind medical feeding
interventions.

Canadian Pediatric Society, Nutrient needs and feeding of premature infants,
  http://www.cps.ca/english/statements.N.n95-01.htm

Carver et al. Growth of Preterm Infants Fed Nutrient-Enriched or Term
Formula after Hospital Discharge. Pediatrics Vol 107 No. 4 April 2001

Hall, T & Carrol, R. Infant Feeding "Pediatrics in Review" Vol. 21 No 6 June
2000

Hall, T. Nutritional Follow-Up of the Breastfeeding Premature infant after
Hospital Discharge" Pediatric Clinics of North America. Vol 48 No 2. April
2001

Hay et al.  Workshop summary: Nutrition of the Extremely Low Birth Weight
Infant. "Pediatrics" Vol 104 No 6 Dec 1999

Kuschel, C. Multicomponent fortified human milk for promoting growth in
preterm infants.  "Coichrane Database System Rev" 2000

Lucas et at. Randomized Trial of Nutrient-Enriched Formula versus standard
formula for postdischarge Preterm Infants. "Pediatrics" Vol 108. No 3. Sept.
2001

Reis, et al. Enhanced Growth of Preterm Infants Fed a New Powdered Human
Milk Fortifier: A Randomised, cointrolled trial. "Pediatrics" Volume 105 no.
3 September 2000

Schanler et al Feeding Strategies for Premature Infants:  Beneficial
Outcomes of Feeding Fortified Human Milk versus Preterm Formula.
"Pediatrics". Vol 103 Num 6. June 1999

Schnanler.  The Use of Human Milk for Premature Infants.  "Pediatric Clinics
of North America" Volume 48 no 1 Feb 2001

Warner et al Growth and Metabolic Responses in Preterm Infants Fed Fortified
Human Milk or a Preterm Formula. Int J Clin Pract 1998 June Vol 52 No 4



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Date:         Tue, 9 Apr 2002 09:44:05 +1000
Reply-To:     Lactation Information and Discussion

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