Lest this sound like a rant (which it is not), I would like to preface
my posting with the quotation that "iron sharpens iron", meaning that
people sharpen people. Geoff has stimulated an interesting discussion
which, I've noticed, has caused us to examine more thoroughly what we
know and believe about cup-feeding. This said, may I toss another
alligator into the swamp? Read on.

>> Do you know what infant lung maturation is at 30 wks?  Medically
>> assisted for short.  You orally feed a 30 weeker via any method and
>> your (sic) risking it's longevity if not it's life.  Again the
>> research is out there.

Is it? Or is it, too, biased?

Neonatology is still a relatively new field. It developed in a medical
vacuum of sorts, meaning that other specialties usually did not (do not)
actively manage the premie. (For instance, if you need a gyn exam, you
could go to a GYN, a family practice physician, an osteopath, a nurse
practitioner, an endocrinologist, an internist, a midwife - all of whom
are capable but trained with slightly different perspectives. You have a
premie? Only a neonatologist provides care. Thus the perspective has
remained biased, out of necessity originally.)

Our style of VLBW premie care is based on "let's try anything and when
something works, let's keep doing it" method of research, simply because
nobody had anything better to offer originally. But who really knows
what is "normal" in utero, whether it is lab values, developmental
behaviors or? Can you see any IRB committee approving good research for
determining *that*?

Neonatology is now stabilizing as a field, and people are beginning to
challenge Rule #7 ("We do it this way because we've always done it this
way"). Also, various therapeutic approaches have been around long enough
to capture longterm outcomes, thus the sad news against surfactant
therapy, originally hailed as one of the greatest breakthroughs in
neonatal medicine.

Thus, people such as Dr. Marina Marcovich in Vienna, have questioned the
prevailing "wisdom" about <30 week gestation lungs and found that they
are indeed capable of *UNassisted* function; in fact, she maintains that
it is our very "medical assistance" that may be damaging these fragile
lungs (average mechanical support, when needed, in her NICU is 6 days).
Thus, she has experience - and data - and videos, too - showing that 785
gram infants at 27 weeks gestation can and do suck/swallow very nicely,
if you please, from a syringe AND directly from mom's breast FROM
BIRTH!! She starts stabilized premies on oral feedings - this usually
occurs by 3 hours of age - & this includes her 25 weekers. She has not
used much TPN (10 days average use in her NICU), but she also does not
"drown" the babes, keeping fluid intake to a very modest 60-70 cc/kg/day
at first, then very gradually increasing over time. Risking life? Not
according to her data: 80% survival for <1500 gm birthweight, with no
grade III nor grade IV brain bleeds, 80% normal development (no
morbidity such as blindness or hearing loss), and - ta da! - 75%
breastfeeding rate in this population. Two additional NICUs in Germany
have adopted her approaches and are seeing very close, very similar
(outcome) numbers. These are nearly mirror image opposite numbers from
most NICUs worldwide (20%+ survival, 20% normal development, grade III &
IV bleeds, minimal breastfeeding).

It is good to question our beliefs from time to time. It is even better
to change our behavior when confronted with new evidence contrary to
what we thought we knew.

This is the true value of LactNet, BTW.

Sincerely,
Katharine West, BSN, MPH
Sherman Oaks, CA