Sophie--the baby with a congenital heart defect, cleft palate and Dandy
Walker Cyst... is taking EBM fortified with polycose and vegetable oil per
bottle.
>...pre-term infants grew at in utero
>rates when breastfed and fed by spoon a mixture of sugar and coconut oil
>(complex fat blend includes MCTs): very palatable, very little intolerance
>including D & V. ... Is this mother unable to breastfeed normally and
>supplement separately? That was a 1989 J Trop Paediatr. article, first
>author Singhania.
AUTH: Singhania RU; Bansal A; Sharma JN
CITE: J Trop Pediatr 1989 Apr; 35 (2): 77-81
ABST: This study was undertaken with the aim of providing adequate calories
for optimal growth in low birth weight (LBW) by fortifying human milk with
medium chain triglycerides and sugar. Twenty-one LBW babies with birth
weight between 1.0 and 1.75 kg and gestational age 28-36 weeks constituted
the study material. They were administered expressed human milk, initially
with gavage and then by spoon. Coconut oil and sugar were added to increase
the caloric density to (0.8 cal/ml). The aim was to achieve a caloric
intake of 200 cal/kg. This was achieved between 6 and 11 days of birth.
Additionally, vitamin C (50 mg) and vitamin E (25 IU/kg/day) were
administered. Weight was recorded daily to the nearest 50 g. Head
circumference was measured weekly using a non-stretch tape measure. Blood
urea nitrogen was measured once the neonate started taking high calorie
feeds. Stools were examined daily for the presence of fat globules and
reducing substances and for the pH. All but one neonate tolerated the feeds
well and there were no complications, such as vomiting, diarrhoea,
abdominal distension, or necrotizing enterocolitis. The weight gain
recorded was 17.29 +/- 5.30 g/day or 13.95 +/- 5.52 g/kg/day. The study
demonstrates that optimal growth can be achieved within the metabolic
tolerance of low birth weight infants by administering fortified high
calorie breast milk.
COMMENT: It certainly sounds as if it might have better results than the
mixture this baby's health care team is currently using. Since the type of
veg oil was not specified, however, it may be that indeed the baby is
getting an MCT blend at this point. I am in agreement with Maureen that
separating the breastfeedings from the supplementary feedings would be
better. The baby needs to get to the breast so that there is a positive
association and reward for eating. However, we don't know how severe or
extensive the cleft palate is, or whether an obdurator is being used (or
needed) to facilitate breastfeedings. I also do not know what a
Dandy-Walker cyst is; none of my books mentions it, but from the comment
about the neurosurgeon placing a shunt to drain off excess cerebrospinal
fluid from the cranium, I wonder if it is encephalic? Certainly this would
seem to be part of the picture, despite the neurosurgeon's belief that it
does not contribute to anorexia/nausea/vomiting. Also, what rate of growth
could optimistically be hoped for with this constellation of defects (there
may be more than these three)? There is a limit to how hard one can push
the baby. I certainly hope there is a dietitian on this baby's health
care team; this case needs someone with more information and involvement
than I have to look carefully into all the details in order to know how to
proceed.
I am almost ill, thinking of the profit the company must be making to be
charging $200 per week for fortifier for this tiny infant, and the profit
to the insurance company by simply turning its back on its insuree rather
than confronting the fortifier company over what it clearly perceives as
inflated pricing. If, indeed, coconut oil promoted better weight gain and
less vomiting, a side benefit would be the economics of using a simple
food.
Arly Helm [log in to unmask]
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