In response to Jan's comments:

Yes, the Schanler study used PREMIE donor milk.  Again, it would have been nice to know the 
breakdown on the gestational age of milk from moms of premies and the nutrient composition - 
but this may have been a decision of the journal editorial staff.  Often there are space limitations 
on articles.

In response to Dr. Jay Gordan's comments:

A full discussion of negative study findings is always very useful.  As, illustrated previously, the 
initial negative findings on vitamin A and morbidity spurred a slew of research that ultimately 
showed that the wrong definitions (incidence versus prevalence and severity were being used) and 
confirmed definitively that vitamin A had a huge impact on childhood mortality in deficient 
populations.  That very heated and often emotional (from some otherwise very evidence-based 
scientists) discussions yielded something of great benefit to the world's children.  A remember 
that providing calories was not enough and that one had to deal with the totality of nutrients.  
Most xerophthalmia is now a thing of the past and the subclinical varieties of vitamin A deficiency 
have declined substantially.  It triggered much more needed work on other nutrients too.  As I 
recently found out, the Plumpy Nut supplements for the climatic disaster in Niger are no longer 
the "milk-based" or vitamin C, niacin, vitamin A, other other nutrient-deficient, but primarily 
calorically adequate supplements of the past.  This supplement does contain all of the nutrients 
needed.  When I was in Niger in 1985, not one of the organizations that were mopping up after 
the famine were the least bit interested in hearing that there was more involved in saving children 
than just calories.

Not only are discussions useful for the particular study in question, but they are useful in general 
to keep our eyes open when we are reviewing other negative studies.  Who knows, but some gem 
of insight might trigger a response that might then generate the next study that then may provide 
clues for how to deal with these exceedingly fragile babies. 

Its not my area either- I work with babies out of the hospital (and can only be reluctantly dragged 
into hospitals by exceptionally pleading mothers), but I still find this interesting on many levels.

Best regards, Susan E. Burger, MHS, PhD, IBCLC

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