I am generally not impressed with the practice of adding formula powder to breastmilk. I understand that some premature infants need protein fortifiers when in the NICU, but usually by the time they are discharged, they are able to take in sufficient volume to not need fortification.
I notice that in many cases, adding formula (not the protein fortifier) to expressed breastmilk becomes a practice when a NICU baby is coming close to discharge time, and is not gaining enough. The babies are usually fed every 3 hours, which is not often enough to gain sufficient weight. So instead of feeding the baby ad lib with breastmilk, the baby is given fortified breastmilk so that they baby does not need to eat more often than every 3 hours.
My concern is the high solute load when adding formula to breastmilk. It seems to me that if a baby needs more calories, simply increase the volume of breastmilk. IF there is not enough breastmilk and no donor milk available, then give normally diluted formula. I feel that they should be feeding 'normally' with the free water that accompanies the added calories.
We have no evidence that adding powder to breastmilk is safe for the kidneys in the long run.
I personally find that these babies are fussy, gassy, and don't eat as well. When the fortification to the expressed milk is stopped, the baby feels better and will take higher volumes of expressed breastmilk, and will eat much more often.
The only caveat to this is if the baby has a fluid restriction, such as a baby with heart failure. The vast majority of babies who leave the NICU don't have a fluid restriction.
Anne


Anne Eglash MD, IBCLC, FABM
Clinical Professor, Department of Family and Community Medicine
University of Wisconsin School of Medicine and Public Health
Medical Director, UW Lactation Services
Medical Director, Mothers Milk Bank of the Western Great Lakes
Founder and President of The Milk Mob, dedicated to building Breastfeeding Friendly Medical Systems and Communities



Date:    Tue, 24 Jan 2017 10:12:46 -0500
From:    Ilene Fabisch <[log in to unmask]>
Subject: Prematurity and formula/breastmilk recommendation

So I have a mom that had a baby prematurely and was given the information to put 1 tsp of Enfacare into her 2oz of pumped milk bottle thereby increasing the calories to 24/oz.

A couple issues with this.
1. Isn't that going to put solids at the wrong dilution ie: too much proteins?
2. What about the CDC recommendation that powdered formula be added only to very hot water to kill exisiting bacteria in the powder for the first 4mos?

Input please!

Ilene Fabisch, IBCLC/RLC
A Gentle Beginning Lactation Assistance
Breastfeeding Coordinator at local WIC prgm

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