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From:
Maureen Allen <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Sat, 6 Apr 2002 16:29:16 EST
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I have been reading all of these posts and it's been very interesting.  If
anyone can make a human milk fortifier out of human milk, I'd be more than
happy to use it.  It's not only calories that are an issue here, it's
nutrients, like calcium and phosphorus.  Lactoengineering by hindmilk pumping
does not change those values, only the fat content, unfortunately.  Preterm
milk is made only for the first 4 weeks or so of lactation.
Now, I have another question.  Many preterm babies in the NICU need
ventilator support and receive artificial surfactant--without these
treatments, many babies would die, like JFK's son, Patrick(who was a 34
weeker, by the way, "full term" by today's standards), in the early 1960's
when we didn't have them.  These things are not natural or usual for
babies--does anyone think that we should not use them?
I know that other countries push the fluids per kilo to 200-300 cc/kilo(we
use 150-160 cc/kilo)  to make premies grow.  It's not done here.  Between
reflux(which a lot of premies have, and maybe more would if we pushed fluids)
and varying degrees of respiratory distress syndrome, both which may increase
in severity with these kinds of fluids.  There's no way in Hades I'll get a
Neo to do that.  It would be seen as really bad care.
We do not fortify if the baby  is over 2 kilos.
As far as the NICU stuff, and this is a quote from our nutritionist, "I don't
care what we feed them, as long as they grow."  We are not just concerned
about a weight number--it's also just as important that they grow in length
and head circumference.  That shows us that the bones are healthy and that
the brain is growing.  I know I'm simplifying this, but we have to use the
best means available to help these babies be the best they can be.  Some of
them have so many things going against them.
Until someone comes up with a totally safe way to feed premies what they need
to grow, I think that many of us doing the best that we can with what is
available.
                                                        Maureen Allen
RN,BSN,IBCLC, NICU LC
                                                        Brigham and Women's
Hospital
                                                        Boston, MA

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