Valerie asks:
If we believe that human milk is the gold standard, what is the
basis for
belief in human milk fortifiers and lactoengineering of human milk?
Is it
human milk is the gold standard only in the full-term and/or healthy
infant?
How do we rationalize this need to change this precious liquid into
something
science believes must be better for the compromised infant?

I fully agree that we need good evidence before "messing with mother
nature".  However, in the case of very early babies (sometimes
referred to as micropreemies) we are already changing the natural
state of things.  The natural state would be for these babies to
die!  We know that human milk changes for the early baby, but it
does make sense for this to apply for the babies who have a chance
to live without intervention.  With technology, many babies survive
who would never have had a chance not many years ago.  I've been
working in OB for less than 20 years (much longer with nursing moms)
and have seen the survival rate and lowest viable gestational age
change tremendously.  Not long ago, anything less than 27 weeks was
considered to be fatal.  Now babies several weeks earlier are being
saved.  We had on that was, I believe, about 24-25 weeks and only 10
ounces that survided!  As another poster indicated - technology
changes faster than human evolution (or adaptation or whatever term
you prefer).  Therefore, it does make sense that these babies who
are surving artificially may need some intervention with their
natural diet.  There may not be such a thing as a "natural" diet for
babies who are not surviving "naturally".  Yes, it is an area that
is experimental.  However, since the situation is already
"experimental" in a way, it doesn't make sense to take a "hands off"
approach until interventions are fully proven.  To not intervene is
an intervention in a way if it reduces the chance of survival once
an early baby has been born.

Winnie

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