Holly writes;
>>Dr. Wight:

I'm sorry I did not make myself very clear. I just included the complete =
recommendation in my post. I do believe in the need for fortification for =
VLBW babies. without a doubt. My concern is the part about the 1600-1800 =
gramers who are going to be sent home on 3  bottles of high calorie =
formula until they are 8-12 weeks of age. This will mean that the majority =
of our babies being discharged from the unit will be going home on =
bottles. Is there strong evidence that all 4# babies need to be supplemente=
d with hi cal formula for 2-3 months?<<

Holly and Dr. Wight,
 Did you see my post from earlier in the week regarding the 34-35 wk twins?
(The smaller twin was less than 4 lbs BW)
They gained 9&11oz in 6 days, between weeks 2-3 of age on breast milk that
was at least 90% breastfed and w/o fortification.
I see this quite frequently so why the need for supplementation here and more
importantly, why the need for a generic dictum?  These babies were d/c'd
largely bottle fdng., but were switched to the breast when it was determined,
by me in this instance, that it was appropriate to do so. Their weight gain
obviously supports my decision and also supports the idea that appropriate
gain for this "group" can be attained without brmilk fortification IF there
is appropriate f/u with a plan of care tailored to the individual rather than
a generic group. If we had waited to increase the brfdng. til the smaller
baby was 2-3 mths. old (the better feeder of the two, btw ), as the hospital
plan suggests, we would have inflicted a disservice on this baby and mother!
Never mind the fact that in this instance, it makes no sense!
Lynn Shea Rn,Bsn,Ibclc
Franklin, Massachusetts

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