The protocols, table, recommendations by AAP, ESPEGAN, etc. are based on  
science and randomized controlled trials (RCT) as well as experience.   We 
still don't know how a 24 week infant is supposed to grow  outside the uterus 
- they didn't survive before.  We also know that faster  growth is not 
always better in the long run - eg. to get optimal brain growth  and IQ you need 
18 g/kg/d weight gain, BUT at this level you increase the rate  of obesity, 
heart disease, hypertension.  What is the best rate of growth  and the most 
important nutrients, in what concentrations we still don't know  exactly 
after 100 years of trial and error, then carefully conducted  research.  
 
The science took a giant leap with Dr. Zeigler analyzing the body  
composition of stillborn babies at various gestational ages (are stillborns the  
same as liveborns?) to get the average accretion rates of various macro and  
micronutients over the entire gestational range.  From there we have  
thousands of different studies - some poorly and some well-done.  As new  
information becomes available the experts revise their recommendations - and  don't 
always agree.
 
Preterm and ill infants are very different from healthy term infants, and  
have very different nutritional requirements.  The age of changing  
something, then trying it out (without a RCT) should be at an end, but for  formulas 
it is still there.  
 
Nancy
Nancy E. Wight MD, IBCLC, FABM, FAAP
Neonatologist, San  Diego Neonatology, Inc.
Medical Director, Sharp HealthCare Lactation  Services
Sharp Mary Birch Hospital for Women and Newborns
[log in to unmask] (mailto:[log in to unmask]) 

BREASTFEEDING: The Best  Health Insurance

             ***********************************************

Archives: http://community.lsoft.com/archives/LACTNET.html
To reach list owners: [log in to unmask]
Mail all list management commands to: [log in to unmask]
COMMANDS:
1. To temporarily stop your subscription write in the body of an email: set lactnet nomail
2. To start it again: set lactnet mail
3. To unsubscribe: unsubscribe lactnet
4. To get a comprehensive list of rules and directions: get lactnet welcome