Last week a medical doctor did what too few doctors do in T&T, he came out of his crease and made some pretty pungent comments about a case he was involved in. Dr Valerie Alexandrov, the forensic pathologist at the Forensic Science Centre in Federation Park, was speaking to reporters about the death of the three month old who had died in what initially appeared to be mysterious circumstances whilst at a Day Care Centre in Diego Martin.
After the preliminary autopsy had been done, samples of the baby's lungs were sent to the Pathology Department at POSGH where one of my former students, Dr Shaheeba Barrow, Head of Pathology, was able to diagnose pneumonia as the event that unfortunately killed the baby.
This sequence of events is a not uncommon occurrence in autopsies. The gross pathology, the opening up of the body and the observation of body parts, is only the initial event in an autopsy which cannot be considered complete without microscopic and other tests (e.g analysis of body fluids, cultures etc) being done. Unfortunately it seems to have become the norm for the family and media to accept the results of the gross analysis of the body as gospel, hence much of the confusion surrounding autopsy results.
Dr Alexandrov went even further than clarifying the cause of death. He was moved to comment on the medical circumstances surrounding this poor baby's death. The comments and advice he gave are simple and effective and though he is not a paediatrician as he clearly stated, his information was spot on and he must be saluted for his words. Here they are with some personal comments.
"The family informed me that the child was sick for a week prior to death and they were saying that this was just a simple cold. Now, children at this age, they are immune defenceless...so the baby was on formula and antibodies are the only substances that cannot be recreated in the formula because it is coming from the mother's breast milk, so the baby was on the formula and so she was immune incompetent."
This is quite true. Newborn babies have little defences, antibodies, white blood cells and so on, in their blood and body against the germs they encounter second by second. They depend on their mothers for antibodies which are passed on to them in the womb through the placenta and after birth through the mother's breastmilk. That's why the breast is often referred to as the second placenta. Every infection the mother has had in her life produces antibodies in her blood which she passes on to her baby. Formula, coming from cows, and a variety of cows at that, does not pass on this immunity because formula is simply partially modified cow's milk which has immunity against the infections the cows have had. This is quite a bit different, no, to the immunity in a particular mother's milk which is specific to her and to her baby.
Human milk is not "merely nutrition." It contains growth factors that stimulate the development of the gut, the heart, the lungs, vision, coordination and IQ. It contains hormones like insulin and thyroid. And of course it is "anti-infective". None of this speaks to the psychological advantages of holding your baby skin to skin but which might explain the fact that child abuse is virtually unknown among breastfeeding babies.
So a mother's breastmilk passes on many more things than Dr Alexandrov suggests (there was no need for him to know this) because any mother's milk contains many hundreds to thousands of distinct bioactive molecules that not only protect against infection and inflammation and contribute to immune maturation (beginning at abut six months after birth) but also to organ development (brain, heart, lungs, liver etc) and healthy microbial colonisation, especially of the gut which in turn protects the baby against pathological bacteria and viruses. None of these substances are present in formula. Some of these molecules, eg lactoferrin, are being investigated as novel therapeutic agents.
A mother's milk is also a dynamic, bioactive fluid. Human milk changes in composition, from the appearance of the first milk, colostrum, to mature milk, which itself varies within feeds, diurnally and between mothers. All according to the growing, developing and anti-infective needs of the baby.
That is why the good pathologist could firmly suggest, "So with the viral infection, it went unstopped and it eventually killed the baby."
And that is why he went on to say: "Children from day one to one year, they are very vulnerable because the children are born without immunity at all, they don't have immune competent organs, so they receive antibodies from mother, and children only start to develop their immunities from the age of six months, so from day one to six months they are especially vulnerable and very susceptible to viral infections, which start usually as a regular cold and then it progresses and, in most of the cases, they end up with pneumonia, so my advice is breast milk.
"I'm grandfather and father and my granddaughter is on breast milk and still is and she did not have single episode of cold over one and half years and she lives in Detroit (in the United States)...so my advice is not to take the so-called cold easy because young mothers should always keep in mind that children at this age could have complication even from an innocent infection."
From one grandfather to another, thank you.