It is often forgotten in the discussion on premature babies that there are premature babies and there are premature babies. In my own experience (limited really to Africa), a 32 or 33 week gestation baby can grow very well on breastmilk alone. Obviously if they are further along, they do well at least as well. Unfortunately, many of those making pronouncements on premature babies and the inadequacy of breastmilk for them, are getting their experience from NICU's where they never see "normal" premature babies. Does it make a difference? You bet it does. A normal 33 week gestation premature can be fed from day one with colostrum and then be given large amounts of breastmilk by tube or cup until he is breastfeeding well. (Actually, even in Toronto, we have 33 week gestation babies, and younger already latching on and breastfeeding--obviously not in the "teaching" hospitals where they know all about feeding prematures, but in the little community hospital where I work). The baby can get amounts that neonatologists would never think of giving babies on ventilators. We gave 250 or more cc/kg/day to our prematures, though this was not always necessary. The other point that we constantly need to remember is that it is not proven that prematurely born babies need to grow at intrauterine rate. This is dogma, and there is no proof that a baby who we can get to grow at intrauterine rate is better off than the one who grows a little slower. The intrauterine growth rate is, in large part, the basis for recommending fortifiers. What if the baby is only 26 weeks gestation though? Well, we don't know. We are dealing in unknown territory. Likely, such a baby would not have survived in nature, and nature made no allowance for him. Perhaps, maybe even it is likely, fortifiers are necessary in this situation. After all is said and done, I think we have to remember that premature babies are also individuals and that there is very little research to tell us what the best thing for these babies is. One thing is sure. The antibodies and cells, the species specific fats and proteins in his mother's milk are much more likely to do him good than harm. If Dr. Lucas said all that was posted, shame on him. Jack Newman, MD, FRCPC