On 3/3/04 7:48 PM, "Automatic digest processor"
<[log in to unmask]> wrote:

>A client contacted me as her pediatrician has suggested she bring in an
>expressed breastmilk sample to spin for a crematocrit as he suspects her
>milk is not "fat enough".

There are at least two problems with this assumption.
The first is that to establish this mothers breastmilk fat content it would
be necessary to measure fore and hind milk content from every feed from both
breasts for 24 hours together with her milk production.

The second is that there is a wide variation in normal fat content (eg:
29g/L/breast vs 62g/L/breast/24hours with both mothers having thriving
babies) Research has shown that the average fat content is also hugely
variable not only in the short term (between feeds) but also in the long
term (over the course of lactation) and is of little value in assessing
energy intake of a breastfed infant. In fact research has shown that the
only variable so far correlated with infant growth is the volume consumed.
Fat content has not been shown to be correlated to infant growth in
exclusively breastfed infants. This is outlined in the references below


Mitoulas LR. Kent JC. Cox DB. Owens RA. Sherriff JL. Hartmann PE. Variation
in fat, lactose and protein in human milk over 24 h and throughout the first
year of lactation. [Journal Article] British Journal of Nutrition.
88(1):29-37, 2002 Jul.


Mitoulas LR. Gurrin LC. Doherty DA. Sherriff JL. Hartmann PE. Infant intake
of fatty acids from human milk over the first year of lactation. [Journal
Article] British Journal of Nutrition. 90(5):979-86, 2003 Nov.


Butte NF et al. Human milk intake and growth in exclusively breastfed
Infants J Pediatrics 1984: 104: 187-95.

Cregan M & Hartmann PE. Computerized Breast Measurement from Conception to
weaning: Clinical Implications. J Human Lact 15(2): 89-96.

Also, as other people have mentioned if this baby is otherwise healthy and
has not suddenly crossed percentiles, someone has to be on the 5th
percentile.

Regards
Cathy Fetherston CM MSc IBCLC
Biochemistry and Molecular Biology
School of Biomedical and Chemical Sciences
Faculty of Life and Physical Sciences
The University of Western Australia



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