Pamela Morrison, you are absolutely right, and I would like to post your comments on my website and Facebook page. Western assumptions about the risk of women’s milk and the safety of infant formulas mean that many people don’t even realise that to call a bovine adulterant of breastmilk a “fortifier” is both false and misleading in any language or country. That LCs accept this terminology without protest shows how co-opted and comfortable so many are within a system that makes breastfeeding success unlikely. Scandinavian studies as far back as the 1980s and 1990s showed that prems can tolerate much more breastmilk and human protein than they are typically offered.  Thank goodness for your commonsense and experience, I say. There are times when reading Lactnet makes me weep, with rage, frustration, and despair. The lack of awareness of the realities of infant formula is deeply depressing.
Maureen Minchin (IBCLC 1985-2006 among many other things)
www.infantfeedingmatters.com
> 
> 
> Date:    Thu, 18 Feb 2016 08:52:16 +0000
> From:    Pamela Morrison <[log in to unmask]>
> Subject: Supplementation of the preterm infant
> 
> Nuria and Lisa
> 
> This is very interesting to me.
> 
> The LBW babies I've worked with (in Zimbabwe) received exclusive 
> breastmilk-feeding and then received extra calcium and Vit D as extra 
> separate medications.  And later, extra iron as well.  But Human milk 
> fortifier was unknown.  The babies were fed increasing quantities of 
> breastmilk in a careful way and they gained extremely well and were 
> discharged from the NICUs either exclusively breastfeeding or 
> exclusively breastmilk-fed by cup (bottles were not allowed...).
> 
> Looking (with much interest!) at the UCSD SPIN feeding advancement 
> tables, I see that the quantities of breastmilk are a lot lower than 
> what I'm used to, eg feeding a baby born at 1500g only 50ml/kg/day by 
> 5 days of age (I would be used to 150ml/kg/day at this age, if the 
> baby was stable) and then starting on HMF at 8 days (no doubt to 
> boost the baby's caloric intake?)  and also expecting only a gain of 
> only 15g/day.
> 
> In the NICUs in which I used to work with the mothers of prem babies, 
> the expected rate of gain for babies under 1500g was 20g/day, and for 
> the bigger ones we would be expecting a gain of at least 30g/day by 
> the time the baby was discharged home at 1800g.   But the quantity of 
> EBM that the baby would receive at 10 days of age was 180ml/kg/day 
> and would increase to as much as 280ml/kg/day when all the 
> neonatologist was waiting for was for the baby to gain sufficient 
> weight to be discharged.  One of the babies I worked with gained 
> 76g/day on mother's milk alone.
> 
> So the conclusion I'm reaching from reading these Tables, and from 
> reading other material about feeding VLBW babies or ELBW babies is 
> that they are often fed extremely low quantities of breastmilk, 
> resulting in very low weight gain, thus rationalizing the "need" for 
> HMF to boost calories/protein/micronutrients.  I found a recent paper 
> authored or co-authored by Paula Meier which suggested that the 
> babies in her study were only receiving 100ml/kg/day of breastmilk, 
> to which was added fortifier. The fortifieer seems to be mixed 1:1 
> with human milk. And yet the WHO guidelines on feeding premature and 
> low birthweight babies at 
> http://www.who.int/maternal_child_adolescent/documents/infant_feeding_low_bw/en 
> suggest, "VLBW infants who are fed mother's own milk or donor human 
> milk should not routinely be given bovine milk-based humanmilk 
> fortifier...... VLBW infants who fail to gain weight despite adequate 
> breastmilk feeding should be given human-milk fortifiers, preferably 
> those that are human milk based."  Thus we come back again to how 
> much EBM to feed a baby in order for the baby to gain "adequate" 
> weight.  So the quantities set out in the UCSD SPIN feeding 
> advancement guidelines seem very low to me.
> 
> Would anyone care to comment?
> 
> Pamela Morrison IBCLC
> Rustington, England
> ----------------------------------------------

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