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