Tarah

Thanks for giving us such a tantalizing and good description of this new 
study.

Something not mentioned, but which I'm *really* wondering about is how many 
of the VLBW babies were *exclusively* fed on human milk, either pasteurized 
donor, or their own mothers' milk?  Richard Schanler is the ardent 
proponent of human milk fortifier, right?  He had an article in JHL a few 
years ago. And of course we know that human milk fortifier is actually a 
cow's milk based additive to human milk to beef it up (pun intended) with 
extra calcium, Vit D and other goodies.  Since HMF seems to be the standard 
of care for VLBW babies in the US, is it likely that the babies in this new 
study did *not* receive it??  In other words, were any of them at all 
really exclusively breastmilk-fed?  If not, could that have helped to 
produce the unexpectedness of the results??

Pamela Morrison IBCLC
Rustington, England

At 19:08 05/08/2005, you wrote:
>Date:    Fri, 5 Aug 2005 14:01:58 -0400
>From:    Tarah Colaizy <[log in to unmask]>
>Subject: Re: Donor human milk vs. formula
>
>This is one of those that needs to be carefully read. Its an interesting
>study, and I don't want to be someone who only looks for flaws in research I
>"don't like", its not so cut and dried.
>They studied babies whose moms all provided milk, but randomized those whose
>moms couldn't make enough to get either fortified donor milk or premie
>formula as the supplement.
>
>They found that the rates of NEC and sepsis were no different between the
>two supplemented groups, but were 2.5 times higher in both supplemented
>groups compared to babies fed only mom's milk.
>
>Good things:  babies in both supplement groups got similar amounts of
>maternal milk; randomization worked pretty well.
>
>Design issues that make it harder to generalize the results widely:
>
>they didn't start collecting data until babies had reached about 30% of
>total enteral feeds, and did not say for certain if ALL feeds prior to this
>time were maternal milk or not. Human milk for early feedings (including
>donor) has been shown to be protective.
>
>21% of the kids in the donor group were changed to formula because of weight
>gain issues, but, in line with appropriate "intention to treat" analysis,
>were kept in the donor group for analysis. Based on some back of the
>envelope calculations, if 70-100% of the excess bad events in the donor
>group vs mother group were really in kids who got formula, that explains the
>no difference shown. I suspect that there really was no difference, but I
>wish the authors had described an analysis with those kids thrown out. I'm
>sure they did it, these are top-knotch folks.
>
>They are also very pro-breastmilk for preemies. The discussion clearly
>emphasizes that kids who got all mom milk did better on all fronts than
>those fed anything as a supplement.
>
>Anyway, that's my take on it.
>
>
>Tarah Colaizy, MD, MPH
>Staff Neonatologist, Assistant Professor of Pediatrics, University of Iowa
>Breastfeeding researcher in training!
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