Hi Jay

As a former NICU nurse and professor for a university course, management of
the high risk neonate, I can tell you the issue is not the calorie content
of ABM or breastmilk, rather the caloric cost to the neonate in metabolizing
these substances.  The fat profile in preterm milk makes fats easier to
digest, the protein ratio is designed for the immature infant decreasing
metabolic energy costs as well as the high solute load that the ABM proteins
create on the kidney.  The neonatologist would be well advised to learn
about these issues. This is discussed in Ruth Lawrence and Riordan and
Auerbach texts. Marsha Walker where are you I am sure she will have lots of
references on the issue.

Susan Moxley IBCLC
Ottawa, Canada
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