In a message dated 9/17/2003 9:02:50 PM Pacific Daylight Time,
[log in to unmask] writes:
She is hoping
to have baby switch to Enfamil Infacare asap.   I am lost here, finding it
hard to believe that this could be true about breastmilk, yet wondering how
else
could this have happened... Any input appreciated... thanks, Ann
Conlon-Smith, LLLL, IBCLC
Please search the archives.  We have discussed this many times before.  It is
not surprising that an ex-29 week infant develops either chemical (labs
abnormal only) or clinical rickets if he/she received exclusive EBM.   Although
somewhat different for the first 2 weeks, milk of mothers who deliver prematuely
changes rather quickly to "mature" milk which has insufficient protein,
calcium and phosphorus to meet the needs of a 29 week infant. There is nothing
"wrong" with her milk - it is just meant for full-term infants.

The mother does NOT have to stop breastfeeding, however.  She just needs to
add 2 -3 feedings/day of a fortified formula (EnfaCare or NeoSure) to get
enough protein, calcium and phosphorus.  Any neonatal nutritionist can calculate
the amount of additional nutrients this infant needs, and figure out how much
supplement the infant will require to meet those needs.

Some experts have suggested adding these special fortifiers to expressed
breastmilk.  That can be done as well, for any feedings of pumped milk.  I prefer
to let the infant nurse as much as possible, and use the formula for a few
feedings.  Although you can meet protein needs by increasing the AMOUNT of
breastmilk taken to 250-300 cc/kg/day, it is clinically impossible to get enough
breastmilk alone into an infant to make up the existing calcium deficits and
ensure appropriate growth.
Nancy

Nancy E. Wight MD, FAAP, IBCLC
Neonatologist, Children's Hospital, and Sharp Mary Birch Hospital for Women
Medical Director, Lactation Services, Sharp HealthCare
San Diego, CA, USA
Email: [log in to unmask]

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