Hi Lynn & Laura,

It seems that there may be a wide range of supplementing practices for the
Preemie depending on the area, hospital policy and the neonatologist.

Our hospital currently does not send moms/infants home on HMF, mainly
because of the cost (estimated $.75 - $1.00 per package).  I recently ask
our dietician for  the NICU about this, as this was a thread discussed a few
weeks back.  She stated that IF an infant needed to have fortified breast
milk it is usually done with " a 22 calorie powdered formula.  But again
this is rarely done here.  Most of our infants are off  HMF well before
going home and only the formula fed infants stay on a 22 calorie (going
home) formula.  This again is determined by general health, estimated
calories/Kg/day., current weight, feeding type (continuous or bolus oral
gastric tube/oral feeding) and gestation.  The practioners/doctors use a
formula for calorie calculation and it is adjusted daily or as needed.  I
can't recall the exact numbers but 120calories/KG/day seems to stick in my
mind at the moment.
    Example:  2.2Kg  (lbs. +)  X  120 calories/day = 264 calories/day.
                    264 divided by 8 feedings (every 3hrs) =  33
calories/feeding
                    33 calories/feeding divided by either 22cal or 24 cal
feeding = 40-45 ml per feeding or about 1.5 oz.

For the breastfeed infant the volume might be slightly more using
20calories/oz, as the standard, which equal 50ml or closer to 2oz per
feeding.

Sad to say many of our infants do not go directly to breast before discharge
and are continued with EBM feedings if mom has maintained her milk supply.
But that is another story to discuss.

Our infants range in average gestation age from 22/23 wks to 30/32 wks.  We
have many multiples and the only infants that I have seen that required the
extra calories to go home on were those with severe health issues (i.e.
cardiac, short gut syndrome, metabolic disorders or other such cases).  I
would be interested to here what other hospitals practices are.  Hope this
hasn't been more involved than what you needed  :-)

Ann Slaughter RNC, IBCLC



>
> Subject: Fwd: premie supps
>
> Laura writes;
> <<Believe me, times are a changin' for our NICU kids as some of you know,
> there is no such thing as going home
> exclusively brestfeeding if you started out in life a preemie. Nowadays we
> send kids home on 2 or 3 bottles of Enfacare (or fortified EBM with
> Enfacare powder) because preemies need to catch up with extra protein and
> other good stuff. It took me a long time to come to grips with this
> latest "findings" that breastmilk is yet again not good enough but in some
> ways I can see that preemies are a different population and in the old
> days they just didn't survive.<<
>
> There is lots of evidence suggesting that very early premies require more
> protein, minerals and calories than most pumped milk provides. There is
even
> evidence suggesting that now discharged former premies grow better with
healthier
> bones if given supplemental premie discharge formulas vs. *standard*
> breastfeeding. However, a number of essential questions remain to be
addressed and
> answered.
> For the very early premie, can we enhance lactoengineering techniques to
> increase calorie content (yes!), or protein/mineral content (?)?
> For the hospitalized premie or d/c'd former premie....how do we discern
who
> *needs* the extra (gestational age at birth? d/c?, weight at birth, d/c?)
and
> at what *RISK* to the baby's health in the immediate sense (change in gut
flora
> etc), long term (myriad -many yet to be determined) OR to the success of
> breastfeeding (well documented)?
> Why are we making decisions based on limited research? eg. I haven't seen
a
> study that compares premie d/c formulas to the *optimally supported*
> breastfeeding dyad BUT I have cared for plenty of them and with optimal
support, they
> grow terrifically. I would bet that their bones are just fine too!
>
> Lynn Shea Rn,Bsn,Ibclc
> Frankin,Massachusetts
>

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