I think everyone has supported Cindi in trying to help this mom do what she
knows is best for this ill infant...providing human milk. One thing that Cindi
a. I asked that no one has responded to is the use of HMF. I work in a NICU
of a children's hospital and share an office with the NICU dieticians (of which
2 are currently off breastfeeding their newborns). HMF is intended for
premature infants as it provides extra calcium, phosphorus and zinc necessary for
bone mineralization. If this mother's breastmilk needs fortified to provide
extra calories, which is common for infants with heart defects, she should be
adding a powdered formula to the breastmilk. She should be working with a
pediatric dietician to determind caloric requirements. There should be one available
at the hospital that her cardiologist works at.

These babies do require significant calories to grow and do tire easily. I
agree that kangarooing should still be possible using a nasal canula. Small,
frequent feedings may be better tolerated by this infant than expecting him to
take large volumes infrequently. Working with a OT who has a specialty in
feeding infants is also essential. This baby needs to be managed by a TEAM, of which
the lactation consultant is an integral part.

Cindi, please feel free to contact me off listserve if you have any
additional questions.

Chris Smith, RN, IBCLC, RLC
Columbus Children's Hospital

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