There is a big diff. between talking about what is physiologic to feed a 35
weeker and up vs what to feed the micro-preemies.  The changes in milk
composition seem adapted to help the stronger, stable preemies survive just
being small.  However the weak, ill, or very small babies are another story.
Those would just die, the way they always did in the past, and still do in
places without NICU care.  I heard Dr. Lucas say one thing that did strongly
resonate with me.  He said there is NO physiologic way to feed those very
low birthweight babies other than to design an artificial placenta and feed
them blood. Even breastmilk is not what they would normally draw their
nutrition from for many weeks.  So everything is experimental as far as
those babies are concerned. More and more survive, but many have less than
optimal outcomes.  There are profound ethical implications to the whole
business, but since we seem to have decided as a culture to try to save them
(which is what I'd want to do if it were my daugther's baby) then we have to
look at how to best help them grow and develop normally, and like it or not,
this is experimentation.

That being said, I'd like to see some studies that look closely at whether
human milk can meet those nutrient needs -- esp. with increased delivery of
hind milk and with the use of donor preemie milk, higher volumes, or with
fortification created from human milk sustances (rather than with
fortification of human milk with formula).

Barbara Wilson-Clay BSEd, IBCLC
Austin Lactation Associates
http://www.lactnews.com

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