>a product called Human Milk Forifier.  We use it and have had difficulty with
it causing bowel obstructions on very tiny preemies. <

There are a number of published studies showing NEC and obstruction in
babies fed fortified breastmilk/pre-term formula. No time to check it now
as off to the States in 2 days but I'd do a Medline search for infant bowel
obstruction, fortifiers etc. Agree with every word of Marsha's post. In the
view of the law professor invited to an international ALCA Vic conference
on breastmilk and special care nurseries ( to listen and respond, she
thought to discuss the legal hazards of NICU use of donor breastmilk)
adding anything to breastmilk is manufacturing a new product, and therefore
needs to meet all the safety/good manufacturing practice standards of the
nation, which includes not harming anyone. A survey presented showed that
what paediatricians do is so variable between NICUs and so little based in
research that she advised them that they were actually, in legal terms,
experimenting on children, and were in a very vulnerable position should a
child be harmed (obstruction. calcified kidneys, NEC, allergy all mentioned
as outcomes in some cases). I hope some parent does sue, frankly. These are
cows' milk based stuff that is NOT the optimal way of giving needed
additional nutrients to prems. Their use is rarely noted in studies of
prems and allergic disease or illness, although they have become almost
ubiquitous since the companies began marketing them. You do know that there
is no legal requirement for human clinical trials of such things before
launch, because they are foods not drugs??

The outcome of that conference, by the way, was that the Chair who heard
her comments, an eminent neonatologist, came out quite shaken, saying,
well, it seems the only safe alternative is to get more mothers
breastfeeding their babies (yea!) and since has gone on with the idea of
milk banking, so that clinical trials are being set up to assess outcomes
of use of donor milk...with the support of the Australian College of
Pediatrics and the Perinatal Society. It's great when a conference has such
an outcome for good: our only problem is getting the doctors to come and
learn, and for that we need to invite prestigious international speakers to
say what could be said but would not be listened to if said by locals. You
all know how travelling 500 miles with slides makes you more expert!

Looking forward to seeing everyone who makes it to teh BSC conference: am
sad to be missing ILCA this year but the dates are the same virtually as
the ALCA Biennial National conference in Surfers' paradise (yes, it is
that) so no chance. Maybe 1999..

Maureen Minchin, IBCLC. Christ Church Vicarage, 14 Acland St., St.Kilda,
Vic. 3182 Australia. tel/fax: 61 3 9537 2640
"Taking paths of least resistance is what makes rivers - and people -
crooked." poster in Palmerston North NZ bookshop...