In a message dated 12/12/2007 8:52:43 AM Pacific Standard Time, 
[log in to unmask] writes:

So, that reminded me to ask lactnetters (and especially our neos):
Under what circumstances and for how long is it recommended to add Neosure,
etc to breastmilk?  If adding it to breastmilk, what concentration?
And are NICU's adding powdered formula to hot water to kill bacteria?

Please refer to the LACTNET archives and to the Academy of Breastfeeding 
Medicine's protocol for ex-premies.  The osmolality is fine.  The risk of 
bacterial infection from the powder has been greatly overblown - the real risk is 
incredibly small for a premie grower.  
 
Most 34 week infants (in the USA) cannot transfer milk effectively enough to 
get adequate intake or maintain a mother's milk supply without the mother also 
pumping and supplementing.  The powder is added to EBM to make 22 cals, which 
usually gives enough protein, calcium and phosphorus to meet the baby's 
needs.  A premie going home at 34 weeks (common in the USA) is NOT a full term 
infant.
 
The infant will need the supplement as long as it takes to maintain growth 
labs in the normal ranges (Ca, Phos, alk phos, BUN or pre-albumin) and growth 
parameters following their own curve.
Nancy Wight MD, IBCLC, FABM, FAAP
Neonatologist
San Diego, CA



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