I have a question for the neonatology wise ones.  I'm an RN IBCLC at a
birth center with a level II nursery.  We just expanded our unit and are
now seeing more near term and preterm babies than we did before.  This is
foreign territory for me.  My question is about human milk fortifiers.  The
few times in the past that we had babies getting fortified milk, we were
able to just send them home with enough fortifier to finish out thier
course.  Now that option will be much more expensive.

Our resident physician told me that the NICU where she covers starts their
preemies out on human milk fortifier (HMF) and then transitions them to
Neosure powder as a fortifier prior to discharge.  The rationale for the
neosure powder is that the parents can find it at Walgreens whereas the HMF
is not available at local pharmacies and can only be purchased from the
company by the case, which means they have to buy a lot more than they
need.

What I'm wondering is:
1) What is the rationale for starting with the HMF vs the neosure?
2) Is there a gestational age where it would be OK to start with the
neosure and forget the HMF altogether?
3) Aren't there concerns about bacterial contamination and powdered
formula?  Is it safe to be using it at all?
4) Can anyone point me to some references about the use of HMF that I could
use to improve my scant knowledge base?

Thanks!

Barb Fibich, RN, IBCLC
Feeling overwhelmed in Milwaukee

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