Jessica

If a baby needs a few more calories, how about 
just giving a bit more breastmilk, rather than 
adding fortifier to the existing breastmilk?   If 
breastmilk has 20kcals/ounce and the baby needs 
22 kcals, then that's only 10% more.  So, say the 
baby is receiving 150ml/kg/day, would it be a 
problem for the neonatologist to suggest that the 
baby receive 165ml/kg/day, and would it be 
difficult for the mother to pump 10% more?   In 
the prem unit where I used to do consults, the 
babies who were stable and needing more 
breastmilk to gain weight were graduated to 
180ml/kg/day, and then to a further 20ml/kg/day, 
and then a further 20ml/kg/day more until they 
were receiving more, and then even more etc, so 
that they gained weight well.  Fortifier was 
never used, although Vit D and calcium, and later 
iron, were given as separate supplements.  Having 
_seen_ that this works, I simply cannot 
understand the resistance to the possibility of 
improving the stable pre-term baby's nutrition by 
simply feeding a higher volume of breastmilk 
containing a higher number of 
physiologically-normal, naturally-occurring human 
fats, sugars, proteins - and ultimately, kcals, rather than a "foreign" powder.

Pamela Morrison IBCLC
----------------------------------

I posted this last week but I did it the night 
before a new week started so i wanted to post again so people would see it.

Has there been any recent evidence based research 
published regarding calorie content of 
breastmilk. I know that it varies all the time 
but I can't seem to get the fact into the 
neonatologist’s mindset that breastmilk is not 
20kcal/ounce. So if a baby needs 22kcals it has 
to have a fortifier added because breastmilk 'is 
only 20kcal'. Of course I know that a creamocrit 
would be the answer but hospital won’t pay for 
one so I was wondering if there was anything 
published that I could provide to them so I can increase their education.

Jessica Callahan RN, IBCLC
USA, NC

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