Grrrr... Formula can be best for prem babies’ brains

[annettemarie]

http://www.thewest.com.au/default.as...ontentID=59676

The doctors from Great Ormond Street Hospital for Children and the UCL Institute of Child Health looked at 76 premature babies born in the 1980s who were fed standard formula milk, banked breast milk (donated by other mothers) or an enriched formula with high protein and fat levels.

They found that the babies, now teenagers, fed the enriched nutrient formula had significantly higher verbal IQ and the area in the brain associated with IQ was larger.

Can this be true? And why weren't these babies breastfed by their own moms? Why donor milk? And wouldn't it be better to pump a mom's milk and add the enrichment to that, rather than formula?

[the_lissa]

Good points. Also, banked milk is pasteurized, which kills some of the benefits.

Why no comparison to babies fed by their mother's milk?

The study sounds pretty crappy to me.

[MaryJaneLouise]

Crossposted from BFing forum.

Another instance of crappy "science reporting." You gotta look at the original source document.

I looked up the recently released Isaacs study.
http://ovidsp.tx.ovid.com/spb/ovidwe...16.18%7c18%7c1

It was a followup to a 1998 study of preterm infants. The kids, when tested, were 15-16 years old.

Here's the link to the abstract of the original study:

http://www.ncbi.nlm.nih.gov/pubmed/9...ubmed_RVDocSum

This study was designed to test FORTIFIED high protein/fat "preemie" formula vs. standard baby formula. It included only babies weighed under 1850 g ~ 4 pounds. The study design was fairly complicated:

Infants of mothers who chose not to provide breast milk were randomly allocated to receive either a standard term formula or a preterm formula designed (by us) to meet the calculated increased nutritional needs in preterm infants as their sole diet (trial A). Those babies whose mothers chose to provide their breast milk were randomly allocated to receive the term or preterm formula as a supplement to breast milk (trial B). Intake of trial diet in trial B depended on the mother's success in providing her milk. The volume of formula and breastmilk (if received) were recorded daily to allow the proportional consumption of these milks to be calculated over the study.

So this isn't really a formula vs breastmilk study at all :

[annettemarie]

Originally Posted by MaryJaneLouise

So this isn't really a formula vs breastmilk study at all :

You know, that's a really good point. I'm : too!

[honeybunch2k8]

::

[evlu]

: to everything MaryJaneLouise posted.

From the abstract of the current study, it sounds like the purpose was primarily to show that brain structure -- specifically the caudate nucleus -- can be influenced by early nutrition, not to determine which feeding method produced higher IQ’s (as reported in the media).

The NHS Knowledge Service has a good summary of the study and its (significant) limitations. They conclude that

from the results of this study, it is not possible to draw scientifically sound conclusions about the significance of any direct relationship between diet and IQ.

http://www.nhs.uk/News/2007/Pages/Ea...tureandIQ.aspx

The current study only used *some* of the participants from the original study -- only those born at 30 weeks or less, those who were neurologically normal, and those who were available for further testing. If all the original participants had been included (especially those who were *not* neurologically normal), the results could have been very different. We also need to remember that IQ is only *one* outcome measure -- how many of the formula-fed infants in the original study developed NEC? Or other adverse outcomes?

The original study is actually much better suited to examining the effects of early feeding choices on IQ. (The full text of the original study is available free: http://www.bmj.com/cgi/content/full/317/7171/1481). This study, as MaryJaneLouise mentioned, split participants into two separate trials: formula only (Trial A) and breastmilk + formula supplement (Trial B). Many of the advantages seen for the enriched formula were only significant for the Trial A subjects (those on exclusive formula). It is exceptionally ironic that some in the media are trying to portray the newer study as proof of the superiority of formula, when the original study contains quotes like this:

The higher IQ of children in trial B, who were fed their own mother's milk, compared with IQ of those in trial A has been reported previously

and

The beneficial effect of preterm formula on verbal IQ was seen for boys but not girls and was confined to those fed exclusively on the trial diets (trial A)

and

Our data also show … the higher IQ in children whose early diet included their own mother's milk (trial B) versus those fed solely on formula (trial A).

If only the science reporters could actually summarize study findings with some degree of accuracy :

[homewithtwinsmama]

Originally Posted by the_lissa

Good points. Also, banked milk is pasteurized, which kills some of the benefits.

Why no comparison to babies fed by their mother's milk?

The study sounds pretty crappy to me.

I would attribute it to the fact that banked milk has been killed of its living properties by pasteurizing as well. This is why until my supply was up I demanded that the NICU use my friend's (who had coincidently had a preemies a few weeks before me) breastmilk. They were completely freaked and I had to sign waivers but I wanted my baby to get ALL the benefits of breastmilk. I also drink raw milk/dairy products in general for the same reason.

[Mrs-Mama]

Originally Posted by annettemarie

http://www.thewest.com.au/default.as...ontentID=59676

Quote:
The doctors from Great Ormond Street Hospital for Children and the UCL Institute of Child Health looked at 76 premature babies born in the 1980s who were fed standard formula milk, banked breast milk (donated by other mothers) or an enriched formula with high protein and fat levels.

They found that the babies, now teenagers, fed the enriched nutrient formula had significantly higher verbal IQ and the area in the brain associated with IQ was larger.

Can this be true? And why weren't these babies breastfed by their own moms? Why donor milk? And wouldn't it be better to pump a mom's milk and add the enrichment to that, rather than formula?

Also wanted to point out that if the preemies were being fed breast milk from "other mothers" then the other mothers likely were not donating preemie milk. I was so freaked when I delivered early that I asked the nurse if I would get milk. She calmed me down saying that I would actually make special preemie milk. Apparently it has a different makeup of fat/protein than full-term baby milk. It's good for brain development and packing on the pounds.

[TeaLeaf]

If you keep on reading though:

King Edward Memorial Hospital’s Perron Rotary Express Milk Bank manager Ben Hartmann said feeding programs had improved since the study was done in the 1980s.


He said it was ideal for premature babies to be breastfed by their mothers. If this was not possible, donor milk was next best but if a mother was not comfortable with this, formula milk was used. In all cases, if a baby was not reaching growth targets, nutrients were added to the milk.

Looks like the same day this is made public it's recanted.

I don't know who financed and ordered the study; don't have time to look it up, but that usually helps in making the decision whether it's worth a nickel or not.

[Sandstress]

Originally Posted by annettemarie

http://www.thewest.com.au/default.as...ontentID=59676



Can this be true? And why weren't these babies breastfed by their own moms? Why donor milk? And wouldn't it be better to pump a mom's milk and add the enrichment to that, rather than formula?

Some preemie moms cannot pump enough or any milk. These were preemies in the 1980's so morbidity and mortality were even worse than today. That kind of stress is hard to work around.

On a more objective note, there are a couple studies in the breastfeeding/neonatology literature citing problems with donor millk, which is all coming from milk banks (and therefore frozen/pasteurized) in these studies. It doesn't seem to have the benefits of mother's own milk or even with preemie formula in some cases. There's a lot of research to be done in the area of "lactoengineering" as I've heard some people refer to it: trying to make the donor milk as beneficial as possible.

[annettemarie]

Originally Posted by Sandstress

Some preemie moms cannot pump enough or any milk. These were preemies in the 1980's so morbidity and mortality were even worse than today. That kind of stress is hard to work around.

That's a really good point that I hadn't thought of. I apologize if I hurt anyone with my comment.

[TeaLeaf]

Originally Posted by Sandstress

Some preemie moms cannot pump enough or any milk. [...] That kind of stress is hard to work around.

I was one of those; it took a few days of (impersonal) pumping to get it going. DS was fed formula until I was able to produce enough to switch him completely. I wasn't happy about it but I sure was grateful to have something to feed him that didn't make him sick.

Originally Posted by annettemarie

That's a really good point that I hadn't thought of. I apologize if I hurt anyone with my comment.

No offense taken here Preemies are not the norm.

[kathteach]

Also, pump technology in the early '80s was nowhere near it is today. I have an early edition of The Womanly Art of Breastfeeding which shows all the pumps available at the time and they're pretty crude. Like the Ora-pump, a pump that you power by sucking on a part. Yikes.