dear breast friends,
i have permission to post. mom delivered 3rd baby after partial
placental abruption at 30 wks via c/s. baby girl was 2 lbs, 12 oz and
14 1/2".
she was intubated for a mere several hrs, only required 1 shot of
surfactants, on cpap for 2 days and still has the nasal canulas w/
room air today, at 33 wks. feeding is via nasal gavage. baby has PDA.
mom is putting baby to breast and she obligingly tries mightily to
nurse, eliciting a few drops of milk. truly, to my very limited
experience at working w/ premies in NICU (i usually get them after
they come home!) this tiny dear is recovering from her early entrance
into the world miraculously.
mom is a very experienced bf'er (2 other girls - bf'ed until 3 yrs
with #2, 18 mos w/ the 1st) and passionate lactivist. her previous
daughters appeared to have intolerance/allergy to dairy, so mom cut it
out of their diets, never feeling the need to consult an allergist
when the problems resolved w/ elimination. cow's milk based HMF was
added to premie's diet at 32 wks and w/in 24 hrs, she was vomiting at
every feed. (not even spitting up mom's colostrum or milk before
that). after a full 24 hrs of vomiting every feed, mom requested that
HMF be discontinued. she feels certain that this baby may also have
issues with dairy and doesn't want to expose her any more than
necessary this early.
mom has researched and learned about the human milk based HMF and
requested it for her baby. the hospital has indicated to her that they
don't feel the baby has evidenced true indications of allergy or
intolerance and therefore a need for the human milk based HMF cannot
be justified. in essence, they have denied her request. she did ask
about paying for it herself if cost was the issue and was told that
could possibly be arranged, but the cost is prohibitive (approx $200/
day).
mom is now asking if there is clear research/studies indicating that
her baby really needs HMF. she is very concerned about GM components,
as well. She also asked the nurses if using HMF increases the odds of
NEC and was told there was no evidence that it does. i did check the
archives and gleaned that the liquid version of HMF carried less risk
of infections, but they've been using the powdered bovine version,
which i read on one post does carry the same risk for contamination as
powdered formula...mom wants to know if there are any sources or
studies she can actually show to the hospital indicating HMF carries a
greater risk of NEC.
baby has been off any HMF at all for 4 days now -and only had it for 2
days - and weighs 3lbs, 4oz today. mom understands that weight gain is
not the only consideration when recommending HMF, but she really
doesn't feel the hospital is fully informing her of any potential
risks. she feels like by insisting the baby continue on the powdered
cow's milk form and denying her request for the human milk version,
the hospital is saying, "we have to see it really hurt your baby
before we'll agree to change it". this has caused the situation to
become a bit adversarial and hence my involvement has been requested
by mother. she & the LC have locked horns and are more intent on
proving their points and citing their sources to back up their
positions than anything else right now. i'm hoping to reintroduce the
common ground here.
i am trying to learn what i can to help guide her toward the baby's
best interests here. i did see a cpl of posts in the archives about
premies who were given only mother's (or donor) milk and then
separately given iron and other micronutrients, with testing being
done in some cases to direct dr.s as to dosage and need. i also saw
posts about 'superfeeding' mother's milk instead of using HMF...is
that ever done currently?
my questions are:
is it ever a case by case basis that premies need HMF or is it an
"always this early" kind of thing?
would it be responsible to support mom in requesting no HMF at all if
they won't give human milk -based?
is there anything else mom can say or do to convince the hospital
toward the human milk HMF?
how long do babies w/ these circumstances typically require HMF?
(i read different criteria in the archives but gathered that in
general, they usually don't go home still needing it)
i saw a post by dr. jack newman warning that he thinks we will see
adverse effects from using HMF on premies when they reach teen- or
adulthood, this might have been written before human a human milk
version was available - are there still valid opinions like this? is
this mom wise to consider refusing it?
Thanks in advance for helping me to navigate unfamiliar territory!
Jacqui Morris, BSW
(near detroit, michigan - where we are hunkering down for the worst
snowstorm in 36 yrs starting tmrw!)
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