Gonneke you wrote, "I think that is very well possible to explain to any mom
that, allthough mom's milk is the perfect food for term babies and moderately
premature born babies, nature did not foresee that babies born at a younger
gestational age
than about 32 weeks could stay alive. The nutritional needs at younger ages
differ greatly from those that are more mature and needs to be more like the
food the baby gets in utero."

But Gonneke, why does "Breastfeeding and Human Lactation" by Riordan and
Auerbach say that "compared to term milk, preterm milk is theoretically more
suited to the growth and immunological needs of preterm infants and has
significantly higher concentrations of several components, including sIgA and
other antiinfective properties, protein,fat, sodium, chloride and
iron.....the lipid profile differs significantly from full-term milk with
preterm milk having higher concentrations of medium-chain triglycerides and
long chain polyunsaturated fatty acids." (page 450--second edition)

There is a discussion in this text book about concerns that human milk
fortifiers may affect the bioavailiability and function of human milk
components.  Now, preterm infants in most of these studies were not only fed
human milk but commercial formulas/commercial fortifiers.  So we don't know
how a preterm infant would respond to human milk only.  I suppose we don't do
that kind of research because there is no one to fund it or maybe because we
don't believe that it is safe to feed a preterm infant it's mother's milk
only. Yet, how can we state as fact that the very preterm infant needs
something different, when we don't have that research?  Yes, preterm infants
fed human milk plus commerical formula do better than formula fed infants.
We have that research.  But it might be possible that a preterm infant might
do even better on it's mother's milk alone.  Maybe not.  But why don't we
have those studies?????  I am afraid that I know the answer to why we don't
have those studies.

So my question is, where is the evidence, where is the research that shows us
that mother's milk alone for preterm infants or the very preterm infant gives
us worse health outcomes than mother's milk fortified?  I don't think there
is any evidence.  Until I see that evidence why should I believe that preterm
infants must have their mother's milk fortified or their mother's milk
lactoengineered? (show me the research not funded by the infant formula
industry) Valerie W. McClain, IBCLC

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