More studies are needed on exclusive breastmilk vs any non-human fortifier in 
the NICU. Funkquist 2006 (small study) shows more morbidity and longer 
hospital stays for LBW with fortifier vs exclusive BM, and less successful full 
breastfeeding after release for fortified infants. Lucas 1996 shows more 
infections with fortifier use, while a 2004 Mead Johnson study reports "no 
more" NEC or sepsis with fortifier than typically seen with breastmilk fed.

What kind of fortification do we want? Protein? Premji 2006 in a meta-analysis 
of 5 studies concludes about higher protein (comparing formulas in 
LBW): "Accelerated weight and nitrogen accretion were noted with higher 
protein intakes in 'healthy' formula-fed low-birthweight infants. This benefit 
could not be weighed against the adverse consequences of elevated blood 
urea nitrogen levels and increased metabolic acidosis and neurodevelopmental 
abnormalities."

Calcium/Phos? Bishop 1996 shows that 5 years later, preterms fed 
predominantly human milk, (mother's and donor), had greater bone density 
than those who received formula supplements to mother's milk. Kuschel in 
2001 Cochrane review of available studies finds no support for the 
supplementation of Ca+/Phos. Gross 1987 reported: "The lack of any 
significant effect of early maternal milk supplementation on bone mineralization 
by 44 weeks postconceptional age suggests that these methods of 
supplementation of maternal milk may not be warranted for healthy preterm 
infants."

Multi-component fortification? Kuschel 2004 makes this very unfortunate 
conclusion: "Multicomponent fortification of human milk is associated with 
short-term improvements in weight gain, linear and head growth. Despite the 
absence of evidence of long-term benefit and insufficient evidence to be 
reassured that there are no deleterious effects, it is unlikely that further 
studies evaluating fortification of human milk versus no supplementation will be 
performed."

Vitamin fortifications seem to be OK. Iron is a "no" in studies. Studies also 
show no benefit from glutamine, iodine, or lactase supplementation. Basically, 
while we know that those preterms receiving exclusive breastmilk end up with 
less morbidity, slightly higher IQ's/better neurological development, eventually 
greater bone density, and more successful breastfeeding, the fact that 
fortifiers do increase weight gain (what all the formula sales people focus on) 
seems, to me personally, a little irrelevant.

linda palmer, dc

             ***********************************************

Archives: http://community.lsoft.com/archives/LACTNET.html
To reach list owners: [log in to unmask]
Mail all list management commands to: [log in to unmask]
COMMANDS:
1. To temporarily stop your subscription write in the body of an email: set lactnet nomail
2. To start it again: set lactnet mail
3. To unsubscribe: unsubscribe lactnet
4. To get a comprehensive list of rules and directions: get lactnet welcome