WHY does someone always blame the breastmilk FIRST!!!!
SGA babies often need extra calories, although I have never had one be
hypoglycemic on unfortified breastmilk (unless they were also IDMs) given in
adequate quantities.  Polycose is rarely used anymore - we call it "neonatal
junk food".  Add fortifier when you reach 75-100 cc/kg/day enteral feeds.
Push volumes up to 180 cc/kg/day if the respiratory status allows.  SGA
babies especially need the extra protein, calcium and phosphorus.

No-one is analyzing breastmilk for it's components clinically that I am aware
of - only for research purposes (other than creamatocrits, that is).  It is
not necessary - you measure the result with weight gain, length and head
growth.  As 50% of the calories come from the fat, you may be losing the fat
in your syringe or tubing if the pump is horizontal, the tubing long, and the
feeds given continuously or very slowly.
Nancy

Nancy E. Wight MD, FAAP, IBCLC
Attending Neonatologist,
Children's Hospital and Sharp Mary Birch Hospital for Women
Medical Director, Sharp HealthCare Lactation Service
San Diego, CA, USA

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