There is SOME evidence that ex-premies need fortification after discharge.  
Remember, we are sending them home at 35-36 wks, not at full term.  You can 
get better growth and bone mineral density in the first year with 
fortification/supplementation, but the effect washes out by age 2-8 in most 
studies.  Rich Schanler has a good set of recommendations and a good lecture 
re who needs fortification at discharge.
R. Schanler, 2/2/01, San Diego:
•Can baby consume volume > 180 ml/kg/d ?
•Is weight gain adequate ?
•Are nutritional indices appropriate ? (Albumin, Alkaline phosphatase, 
Phosphorus)
•If ALL responses YES:
       – Exclusive breastfeeding
             • At the breast
             •Expressed BM
             •Combination
       –Term formula
•If any responses NO:
       –Combination BF /EBM + enriched formula
       –Enriched formula

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

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