Wow ljb!  If mom is pumping 1000ml per day she has an excellent supply.
Pat, I think the "someone in Europe" who keeps talking about feeding
premies "just" mom's milk might be me - like a stuck record!  My clients in
Zimbabwe when I lived/worked there, were encouraged to feed exclusive
breastmilk or breastfeeding, as much as the baby wanted, up to
280ml/kg/day, and without fiddling about skimming the cream off the top.

Let's think about why.  The baby needs _all_ the milk, and all the
different components in all the different fractions come in physiologically
correct proportions - the sugars, the fats, the proteins, and all the
different minerals and vitamins in all the different components fractions.
The mother would express to drain the breasts well.  The milk would be
shaken to mix and then fed to the baby as it came.  The prem babies were
given extra Vit D and calcium, and later iron, as separate different
supplements.  But these babies were not considered to need any extra
calories or extra protein as long as the mother could provide as much
breastmilk as they wanted.

Pamela Morrison IBCLC
Rustington, England
----------------------------------------
From:    ljb <[log in to unmask]>
Subject: Lactoengineering mom's milk

Hello Lactnet,
I am helping a 31y/0 primip with a NICU baby born at 28 weeks, now
corrected 2 wks old.  BW was lb 6z (636g) and is now 5lbs5oz.  Baby male is
fed exclusively EBM via bottle and he accepts a shield as well.  The baby
was discharged from hosp. 1.5 weeks ago, and neonatologists were requesting
that mother add fortifier was prolacta and then the enfamil product.
 Finally, he was put on neosure as a fortifier, added to EBM.

When I started helping her the goal was to directly feed, although the
pediatrician wants her to continue to fortify.  She can pump up to 1,000ml
a day and has alot stored.  I want to give her instructions on using her
own milk as a supplement by separating it into high fat and low fat and
using the high fat to add to the milk that he is drinking via bottle. Or,
she could use the high fat milk in a supplemter.

Trouble is I am not finding a protocol or procedure for how to do it
exactly?  She would like some instructions and all i could tell her was to
let it separate and add the fat that comes to the top as her fortifier.

Does anyone out there have such a protocol?  Or know where we could find it?
Thanks so much,
LjBerkeley, IBCLC on the Border with Mexico

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