Please forgive me if this is a duplicate, I got an odd error message when I
first sent it.

Dr. Tieman said  about her friend's ex 25 weeker "He has been averaging in
the last 4 weeks just about an ounce a day weight gain." and "Is anyone
aware of standards for supplementation in the breastfed preemie?"and "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?

There is not a consensus but one point that is repeatedly made is that
preemies need more protein and minerals than breastmilk can provide (not
just additional calories), and that this need continues past 40 weeks
corrected gestational age.  What we are currently doing in my NICU (and we
are reviewing it and not happy with it) is using HMF to raise mother's own
milk average calorie to 24 per ounce and then using powdered formula
recipes to make caloric increases from 24 to 30 calories. In the rare
instance that we have to go over 30 calories we would likely be using an
oil or polycose but it has been a looong time since we have done that and
it would likely be individualized to the baby in need.

At discharge,  we and the other area hospitals  (Baltimore/Washington
corridor) I have surveyed, give mothers instruction for powdered formula
fortification only.   Use of HMF in a discharged preemie is rare here.
This isn't to my knowledge based on any good evidence as much as
convenience and expense.   The advantages of increased ratios of protein
and minerals are decreased and calories are the main thing these discharged
babies are being fortified with.

Another thing your friend could consider is the use of hind milk (if she
has more milk than her baby requires. )

There is also the possibility of fortifying with liquid concentrate formula
to avoid the powdered formula issues with non sterility but in the home
situation this is very expensive as the containers available are large and
the shelf life for an opened container is very limited.   The recipes are
out there if she should decide to go this route and I can probably find
some that I have collected for you if so.

Using liquid concentrate has its own set of problems, ratios of proteins
and calories change depending on the amount of fluid used to make the
concentrate....ie how concentrated the concentrate actually is.

I am told by a formula industry representative that smaller, perhaps unit
dose sized, containers of liquid concentrate will soon be produced.    I
take this all with a grain of salt as our hospital  changes "our" brand  of
formula used and the representatives are all trying to put their companies
best foot forward.

The same industry rep tells me that the company "recommends" powdered
formula not be used to fortify the breastmilk used for prematures.   I view
this as a marketing strategy as much as anything else considering the
source but also perhaps a risk management issue on the company's part as
well.   If a premature does become infected they can then say the powdered
formula was used against their recommendations.

NONE of this is yet in writing  from the formula company (to my knowledge)
(the plans for smaller packages of liquid concentrate and the
recommendations to not use powdered formula for prematures).  It is given
out verbally to me (NICU LC) and the neonatologists and the unit manager
and anyone else who will listen.

             ***********************************************

To temporarily stop your subscription: set lactnet nomail
To start it again: set lactnet mail (or digest)
To unsubscribe: unsubscribe lactnet
All commands go to [log in to unmask]

The LACTNET mailing list is powered by L-Soft's renowned
LISTSERV(R) list management software together with L-Soft's LSMTP(R)
mailer for lightning fast mail delivery. For more information, go to:
http://www.lsoft.com/LISTSERV-powered.html