Nice summary of my thoughts in scientific relevant studies, thank you Linda.
In line with that: how far is research about the effects in growth and health outcomes of using only mom's own manipulated milk? (a la Paula Meier) I know Meier did her own research, but is it reproduced or enhanced by others? And how about the research on human milk based fortifier?
Warmly,
Gonneke, IBCLC, MOM in southern Netherlands
--- On Sat, 4/25/09, Linda Palmer <[log in to unmask]> wrote:
From: Linda Palmer <[log in to unmask]>
Subject: Re: [LACTNET] New formula being promoted in our NICU - help!
To: [log in to unmask]
Date: Saturday, April 25, 2009, 11:49 PM
More studies are needed on exclusive breastmilk vs any non-human fortifier in
the NICU. Funkquist 2006 (small study) shows more morbidity and longer
hospital stays for LBW with fortifier vs exclusive BM, and less successful full
breastfeeding after release for fortified infants. Lucas 1996 shows more
infections with fortifier use, while a 2004 Mead Johnson study reports "no
more" NEC or sepsis with fortifier than typically seen with breastmilk fed.
What kind of fortification do we want? Protein? Premji 2006 in a meta-analysis
of 5 studies concludes about higher protein (comparing formulas in
LBW): "Accelerated weight and nitrogen accretion were noted with higher
protein intakes in 'healthy' formula-fed low-birthweight infants. This benefit
could not be weighed against the adverse consequences of elevated blood
urea nitrogen levels and increased metabolic acidosis and neurodevelopmental
abnormalities."
Calcium/Phos? Bishop 1996 shows that 5 years later, preterms fed
predominantly human milk, (mother's and donor), had greater bone density
than those who received formula supplements to mother's milk. Kuschel in
2001 Cochrane review of available studies finds no support for the
supplementation of Ca+/Phos. Gross 1987 reported: "The lack of any
significant effect of early maternal milk supplementation on bone mineralization
by 44 weeks postconceptional age suggests that these methods of
supplementation of maternal milk may not be warranted for healthy preterm
infants."
Multi-component fortification? Kuschel 2004 makes this very unfortunate
conclusion: "Multicomponent fortification of human milk is associated with
short-term improvements in weight gain, linear and head growth. Despite the
absence of evidence of long-term benefit and insufficient evidence to be
reassured that there are no deleterious effects, it is unlikely that further
studies evaluating fortification of human milk versus no supplementation will be
performed."
Vitamin fortifications seem to be OK. Iron is a "no" in studies. Studies also
show no benefit from glutamine, iodine, or lactase supplementation. Basically,
while we know that those preterms receiving exclusive breastmilk end up with
less morbidity, slightly higher IQ's/better neurological development, eventually
greater bone density, and more successful breastfeeding, the fact that
fortifiers do increase weight gain (what all the formula sales people focus on)
seems, to me personally, a little irrelevant.
linda palmer, dc
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