Throwing two cents in here... while I respect the work of many of the
authors ( despite their funding sources ) who have done such extensive
publication regarding the need for fortification and preterm formulas.. the
one question NONE of them have ever been able to answer when I've asked is
this. In every one of those studies, on the comparision slides of preterm
EBM, Fortified EBM and preterm formula  the caloric and nutrient contents
listed under the EBM column is from a single set of medically "known"
values for preterm milk. BUT... they never again reevaluate the EBM for
nutritional/caloric changes or for variences between each and every nursing
mother. When I remind them that EBM is not a stagnant product and human
milk values change as the infants change, all the researchers have either
replied, "well, I'll have to check with our dietician" or they have ignored
my query.
 Don't get me wrong.. I don't totally disagree that in some cases of
micronates, they might need fortification but my thought is that if we are
using this fortification medically to "treat" a condition, should'nt it be
treated like any other medical concern and clear clinical lab values of the
proposed "lacks" in that infants specific maternal milk be either ruled out
or identified first and then adjusted per infant? Otherwise , it seems to
remain an "everybody treatment" - just done cause it sounds "reasonable". I
can't see how its ( fortification) "benefits" are able to be clinically
justified until research clearly assess, address and compare the varience
of changes that can affect maternal milk values.  Would make for an awful
lot of slides :)
 Couldn't you see it... a speaker up presenting his research and slide
after slide document the changes breastmilk makes while the ol'
fortifiers/formula show their true colors..... as the stagnant product!

Lisa Jones RN RLC IBCLC

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