Carla Danna's post of yesterday discussed the issue of hind milk feeding. As
we did a study on the effects of hindmilk feeding in the LBW population
(Valentine & Hurst, 1994, Hindmilk improves weight gain in low-birth-weight
infants fed human milk. J of Ped Gastroenter and Nut 18:474-477) I am very
interested in the topic. I was wondering were you obtained your information
re. the decrease in immunological components from fore to hind milk. We did
not see a change in the protein content in our study. Other milk composition
studies (Neville; Hansen; Picciano to name a few) did not observe a decrease
in protein or IgA levels. For the infant who is fluid restricted and
necessitates a more concentrated milk, hindmilk feeding seems to be a
relatively easy method to use without adding additional fortifiers which may
adhere to feeding vessels and tubing. We have a large cardiac population and
as you have described they are very difficult feeders. They come to the feed
with less energy and although may look fairly efficient upon observation at
the breast - test weighing sometimes reveals a decrease! in weight -
possibly due to an increase in their insensible losses and respiratory and
cardiac efforts. One problem we have encountered on more than one occasion
is a mother who is expressing her milk for an infant awaiting a heart
transplant. Once the infant receives the transplant the cardiologists order
that the infant no longer can receive mom's milk due to the chances of graft
vs. host disease. Unfortunately I have been unable to find anything in the
literature speaking to this issue. If anyone has any info I would love to
hear from you.

Thanks,
Nancy