12/13/95 Dear all LactNetters, As promised, I'm writing to keep you apprised of the info I have gathered on this subject. I want to send a special acknowledgement of thanks to Dr. Tom Hale at Texas Tech University School of Medicine and Dr. Katherine Dettwyler of Texas A&M University. Those two Texans answered promptly with helpful information. Another very special thank you goes to Dee Keith who has put me in touch with an RN, IBCLC who has extensive experience working with babies receiving bone marrow transplants and who has been successful in establishing protocols that have allowed some of these infants to continue receiving breastmilk during the transplant procedures. As this info comes in I will bring you up-to-date on what I learn. Dr. Hale pointed out 2 possible areas of concern that must be addressed and these are the fact that breastmilk is not a sterile fluid and that breastfeeding could provide a source of infection to an infant that is immunocompromised. This is the reason why the infant will be fed only sterile fluids. Several of you have written to me and asked why couldn't the baby receive sterilized expressed breastmilk. A good question! And, just the one that I hope to get some answers for soon. The other concern Dr. Hale pointed out was the possibility of Graph vs Host disease by the introduction of dissimilar (maternal) set of cells to the infant via breastmilk following the transplantation. Concern for this rejection response probably underlies the doctors advice to this mother to DC breastfeeding. Again, I hope to have more answers on this issue soon. Dr. Dettwyler's post was particularly helpful in providing information that will help me encourage this mother to maintain her milk supply even though she may not be allowed to give her baby her breastmilk during the transplantation procedure. She pointed out the immunological benefits and indicated that all studies to date (even though these studies stop at 2 years post-partum and therefore, fail to follow the health consequences of breastfeeding beyond 2 years pp) indicate that the longer the child is breastfed, the better the infant's health, with children breastfeeding 18-24 months doing better than those breastfeeding 12-18 months and those better than infants breastfed only 6-12 months. I will keep you posted as I learn more about protocols that may allow this infant to receive his mother's expressed breastmilk during the immuno-suppression phase of the transplantation procedure and for the period of time after the transplant during which the infant will be monitored for rejection of the transplant. Diane, thanks for the kind words about my Syracuse presentation. Dee, great fun talking with you last night. LLLoved sharing. (;-) Anna R. Utter, BS, IBCLC [log in to unmask]