Ghislaine asks, and I reply: To my knowledge there are no units currently
tweaking fat content of expressed milk as a routine policy for the smallest
babies.  Human milk fortifier is used, added to breastmilk, either banked or
the mother's own, for the very smallest babies, under 1500 grams.  When they
get past 1500 grams the fortifier is stopped.  Babies discharged from NICU
to home are NEVER receiving HMF at discharge, which I understand does occur
in some other countries.

I've seen a couple of mothers who got off to a bad start with non-latching
babies, began pumping and bottle feeding, and had babies who didn't gain
weight despite their producing far greater volumes than the baby could
possibly consume.  In two cases I have suggested keeping the milk expressed
from each breast separate, letting the containers stand til the cream rises
to the top, and simply decanting the cream from the one breast into the
whole milk from the other, so that the baby can get a higher calorie feed in
a smaller volume, and it has helped in both cases, with the problem
resolving itself when baby gets onto breast.  I don't know if anyone else is
doing this.

Rachel Myr
Kristiansand, Norway

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