I am convinced that somewhere along the path of our evolution babies were
commonly born earlier and that premature babies were meant to survive. The
history of Kangaroo care in remote areas far from health centres shows that
one does not necessarily need a sophisticated state of the art preemie unit
to save these babies. Just look at the Dionne quins - nobody expected them
to survive the night and nobody was more surprised than the doc when he
showed up next morning to find them all alive - what he did next of course
was unthinkable but that is not the topic of this posting.
Pregnant women start producing milk at around 24 weeks of pregnancy and yet
until not so long ago, most preemie units did not expect babies of under 30
weeks gestation to survive. Only now where births are recorded do we see
babies born at 24-25 weeks and against all odds surviving.
Since my clients at prenatal courses start at about 26-28 weeks we always
discuss prevention and care of premature birth. There are always questions
about feeding of preemies and the couples are very encouraged to understand
that if a baby is born so early, the milk his mother is producing is
specially formulated for that baby; if a baby is born at 32 weeks, then the
milk is suited to a bigger preemie and from 36 weeks, the milk is suitable
for a full-term baby . This explains the miracle of the milk changing and
adjusting in quantity and quality for the first six months of the baby`s
life so that nothing else needs to be given to that baby - and of course the
benefits of continued breastfeeding even when solid foods are started.
But starting with the fact that milk is produced by the mother at 24 weeks,
it is obvious that preemies were meant to survive.
Wendy Blumfield
----- Original Message -----
From: "Rachel Myr" <[log in to unmask]>
Sent: Friday, December 14, 2007 12:43 PM
Subject: Premies not meant to survive?
> I'm not convinced that we can say categorically that premies were not
> meant
> to survive. Granted, far more babies who would have died just a couple of
> decades back are now surviving, and surviving with remarkably few
> sequelae,
> but some of them have always managed.
>
> Disclaimers: I am not a neonatologist and my experience working with these
> babies, beyond helping mothers on post partum to establish milk supply
> from
> the start, is when they are ready to graduate from our intensive care
> unit,
> which does have babies down to about twenty-eight weeks. Also, this is
> anecdotal evidence.
>
> My mother in law was born over eighty years ago, weighing sixteen hundred
> grams, which is about three and a half pounds. Her mother expected to
> give
> birth some ten weeks later. Of course, estimation of gestational length
> and
> assessment of gestational age are very different now, but in talking to my
> MIL's own mother it seems she had a tendency to premature labor. She was
> running to catch a bus when her waters broke and my MIL was born a short
> time later. Her mother had three or four early miscarriages or
> spontaneous
> abortions in the ensuing four years. Then she was widowed when her
> husband
> got pneumonia and died of it in the course of two weeks, this being the
> pre-antibiotic era, and my MIL grew up an only child. She was exclusively
> breastfed from birth, though she was too small to nurse at the breast for
> some time. She slept in a shoebox on the shelf over the stove, and her
> mother had to endure all the aunties and their friends coming to pay their
> respects, looking in the shoebox and saying 'Imagine that something that
> small can LIVE!' as though it were an affront to their sensibilities.
> Yet live she did, and grew to normal adult size, with normal enough
> development that she attended school, did well, was employed most of her
> life in a job requiring some considerable intellectual abilities, and gave
> birth to three term babies herself, all of whom are basically healthy,
> mature men today. She developed asthma at the age of sixty, but she lived
> until she was eighty-three herself.
>
> A good friend of mine is fortunate enough to have both her own parents
> still
> alive. Her father is well over eighty. His mother was the district
> midwife
> in the rural community where they lived, and he has recounted for his
> daughter many times how he was born weighing about four pounds, and since
> his mother was the only midwife in her district, she had to simply take
> him
> along whenever she was called out. She gave him what we now call kangaroo
> care, and he was exclusively breastfed from the start. I have later heard
> this story corroborated by young women from the same community, who grew
> up
> hearing about this midwife and how her son came along on births, inside
> her
> blouse, for many months. He is the father of three and the grandfather of
> at least twice that number now, and for all I know he may be a
> great-grandfather as I write this.
>
> Neonatology is an important subspecialty of pediatrics here too, and
> Norwegian neonatologists have done some landmark research on nutritional
> care of extremely small and extremely premature babies. We use human milk
> fortifier much less than what seems to be the norm in North America. We
> also keep babies in the hospital longer, because special care baby units
> so
> far have been spared the pressure to get patients out as quickly as
> possible, whatever the cost. For both these reasons I have never heard of
> anyone being sent home with a breastfed baby on fortifier. If a baby
> still
> needs fortifier, by definition they aren't ready to go home. I honestly
> don't know how many biochemical markers for growth our neos use, beyond
> simply weighing and measuring the babies. I do know that these children
> no
> longer stand out in crowds. They look, and act, pretty much like everyone
> else. It is entirely uncontroversial to acknowledge that the babies who
> thrive on breastmilk are the ones who do best, just as the same is true
> for
> term babies.
>
> Coincidentally, I happened to ask one of our NICU nurses the other day how
> many cases of necrotizing enterocolitis he has seen in his nearly twenty
> year career working in our unit. Only about two hundred babies come
> through
> there every year and of course most of them are not micropremies. He has
> seen three outright cases of NEC and about twice that many in which NEC
> was
> suspected but never confirmed. This is generally attributed to the policy
> of introducing colostrum and mother's milk or unpasteurized donor milk per
> os as soon as possible after birth, especially for the very smallest and
> youngest babies.
>
> I see I need to ask more about our national criteria for using fortifiers
> for extremely premature babies, and if I can remember to do so, I will,
> and
> report back again. I imagine we can all agree that this is an area where
> we
> are learning huge amounts very quickly, and whatever policy we have today
> will likely be different in another few years again.
>
> Rachel Myr
> Kristiansand, Norway
>
> ***********************************************
>
> 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
>
***********************************************
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
|
