There are goals for weight gain in premies, based on fetal growth rates.
There are growth charts, a few different versions. We really don't know what
the appropriate growth rates are for very small premies, but we do the best
we can with the fetal data available. It has been demonstrated that human
milk, even from a mom who delivered preterm, cannot achieve what is
currently considered adequate growth in tiny babies. We use human milk
fortifiers, which are just powdered formula supplements, really, to increase
the caloric density, protein content, and calcium and phosphorus content of
the milk. These are made by the two big formula companies. In the NICU I
work in, instead of not giving babies donor or mom's milk when they aren't
growing well, we just add more fortifier. The standard mixing makes
24kcal/oz milk, we routinely use 27kcal/oz in our nursery, where we use 99%
donor milk or mom milk for babies born at 1500g or less. 


Tarah Colaizy, MD, MPH
Staff Neonatologist
University of Iowa
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