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Subject:
From:
Pamela Morrison <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Mon, 24 Aug 2009 12:40:06 +0100
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Gonneke puts forward an interesting thought, which is consistent with 
the research we've all heard about.    But I'd like us to think it 
through. Research showing that mothers pumping large quantities of 
low-fat foremilk for babies in the NICU still have babies who do not 
thrive misses the point that the total quantity of milk that these 
babies receive is inadequate.  Certainly, increasing the fat content 
of the milk is useful to maintain a certain level of weight gain in 
babies who are effectively on a restricted diet, but why should this 
be necessary??  If neonatologists would "allow" the stabilized 
pre-term baby to be fed increasing quantities of ordinary, 
as-it-comes, breastmilk, then weight gain could be more easily 
increased to achieve in utero growth rates.   Cathy Genna reminds us 
that calorie intake can be enhanced either by feeding more lactose or 
by feeding more fat.  Why should the latter be seen to be "better" 
than the former?  It makes little sense to me to ensure that there is 
extra cream in the pre-term's breastmilk allowance of a mere 150 ml 
per kilo per 24 hours when - instead - these babies could simply be 
fed up to 280-300 ml/kg/day of unmanipulated breastmilk, to enhance 
their lactose AND fat intake, thereby achieving better results in a 
more physiological manner.

And the same goes for full-term babies who are failing to thrive.  A 
baby who is clearly not gaining weight at a normal rate usually needs 
_more_ milk, not less.  Draining the breasts really well will have 
the effect of increasing the baby's fat intake.  But it will also 
have the effect of enhancing overall milk synthesis.  Maybe by 
focusing on the lipid content of breastmilk, we're overlooking the 
most important component determining infant weight gain - lactose?

Pamela Morrison IBCLC
Rustington, England
----------------------------------------------
Gonneke wrote:  With all new discoveries still nothing refutes the 
old LLL adagium:
breastfeed often and finish the first breast first. It is nice that 
that is now so=
rt of proven by research, but does that make it worth more? Will it make br=
eastfeeding and breastfeeding counseling different, or more or less difficu=
lt?

At the other side of the picture are the findings of Paula Meier that fat a=
ctually does make a difference, at least for premies it does. Mums pumping =
large amounts of relatively low-fat milk (for example after a good nights' =
sleep) will have babies that do not thrive in NICU, when they instead use t=
he samples pumped later in the day when volume is less and fat content high=
, babies start thriving and growing.

The more we learn, the more we realize we do not know. Yet, babies and moms=
  do not change that much and the adagium is and will probably stay: breastf=
eed often and finish the first breast first.

             ***********************************************

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