I have posted several different times about my friend's baby, born at 25 1/2
weeks as one of triplets who is the only survivor.  He has been home now for
3 weeks, and was 40 weeks corrected age yesterday.  He was born 10/29/05 and
is 3 mos old.  I'm back with more questions!
Zachary was born at 780 gms(1 lb 11oz), and today weighed 2900 gms (6 lbs 6
oz)  He has been averaging in the last 4 weeks just about an ounce a day
weight gain.  He is fed his mother's milk, half at breast, half by bottle.
He had been nursing fairly well, but seems to have developed some nipple
confusion recently, and tends to pop on and off the breast and root
frantically.  He is on oxygen due to BPD, and takes Diuril and potassium
phosphate.  His neonatologist wants mom to supplement half of the baby's
feedings with powdered formula to increase the calories in the breast milk.
 Mom has tried Enfacare and Nutramigen, adding 1 tsp of powder to each ounce
of milk.  Baby seems fairly unhappy when receiving supplementation, fussy
and gassy.  Several times she has stopped the supplement altogether for a
day or 2 and he is much happier.  She would like to go to exclusive
breastfeeding, but the neo wants the baby supplemented until he is 8 lbs.
They advised her today to try Good Start Soy, so she bought some but hasn't
started it yet.  She was really hoping today that the neonatologist would
agree to let her go to exclusive breastfeeding and monitor baby's growth,
but they are adament that he needs the extra calories until he is 8 lbs.
She's also worried that his recent struggling at breast is only going to get
worse if he continues to receive significant amounts of bottles.
Is anyone aware of standards for supplementation in the breastfed preemie?
Is there any evidence based guideline I could point her to that might help
in deciding how important this supplementation is?  What do those of you who
work in NICUs do?
And in light of the recent discussion of non-sterilility of powdered formula
would there be a safer product to use for supplementation if it is necessary?

Jennifer Tieman
Family Physician
Mom to 4, including my toddler nursling Caroline Rose

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