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From:
Jack Newman <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Sat, 1 Feb 1997 20:24:37 -0500
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It is often forgotten in the discussion on premature babies that there
are premature babies and there are premature babies.  In my own
experience (limited really to Africa), a 32 or 33 week gestation baby
can grow very well on breastmilk alone.  Obviously if they are further
along, they do well at least as well.  Unfortunately, many of those
making pronouncements on premature babies and the inadequacy of
breastmilk for them, are getting their experience from NICU's where
they never see "normal" premature babies.  Does it make a difference?
You bet it does.  A normal 33 week gestation premature can be fed from
day one with colostrum and then be given large amounts of breastmilk
by tube or cup until he is breastfeeding well.  (Actually, even in
Toronto, we have 33 week gestation babies, and younger already
latching on and breastfeeding--obviously not in the "teaching"
hospitals where they know all about feeding prematures, but in the
little community hospital where I work).  The baby can get amounts
that neonatologists would never think of giving babies on ventilators.
We gave 250 or more cc/kg/day to our prematures, though this was not
always necessary.  The other point that we constantly need to remember
is that it is not proven that prematurely born babies need to grow at
intrauterine rate.  This is dogma, and there is no proof that a baby
who we can get to grow at intrauterine rate is better off than the one
who grows a little slower.  The intrauterine growth rate is, in large
part, the basis for recommending fortifiers.

What if the baby is only 26 weeks gestation though?  Well, we don't
know.  We are dealing in unknown territory.  Likely, such a baby would
not have survived in nature, and nature made no allowance for him.
Perhaps, maybe even it is likely, fortifiers are necessary in this
situation.

After all is said and done, I think we have to remember that premature
babies are also individuals and that there is very little research to
tell us what the best thing for these babies is.  One thing is sure.
The antibodies and cells, the species specific fats and proteins in
his mother's milk are much more likely to do him good than harm.

If Dr. Lucas said all that was posted, shame on him.

Jack Newman, MD, FRCPC

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