Right on Kathleen.  I did not respond, because I was tired of being
the only one to ever rail about the "need" to "fortify" human milk.
One of the big problems in medicine is that "standards of treatment"
often come from the quaternary care centres.  So neonatologists who
make the rules tend to see the sickest smallest babies.  And perhaps
for them, fortifier might be part of their rehabilitation and
nutrition.  But that does not necessarily carry over to less sick or
smaller babies.

The thing is that most premature babies are fairly big, often bigger
than 1500 or 2000 grams even, and what might apply for a sick
premature may not apply for a healthy 1500 gram baby.  To his credit,
Schanler mentions this I think.  But it may also be true for a
premature who has had no complication and weighs only 1200 grams or
maybe less.

My experience is from Africa (after the quaternary centre at the
Hospital for Sick Children), and I admit, if the babies didn't make it
with a little oxygen they didn't make it.  But we were able to give
them 200, 250, even 300 cc/kg/day by ng tube, slow drip (like
intrautero--*continuous* nutrition), and they grew fine.  I didn't
know about the fat sticking to the tubing, but it worked anyway.

Jack Newman, MD, FRCPC