I would appreciate some discussion from the NICU LC's and peds,
neonatologists on the use of powdered ABM substitutes eg Enfalac powder as a
fortifier for preterm babies under 2000gms, vs using human milk fortifiers(
also produced by the formula companies). I work primarily with healthy term
babies and have had limited experience with preterm babies. The request for
info comes from a nurse in the NICU. The high cost of the human milk
fortifier was seen as the main reason for using the ABM substitute.  The
nurse is wondering if other areas are also following similar practices.
There has been some discussion lately about the use of skimmed hind milk to
add calories. This seems like a good option if weight gain is the main
issue. I am speaking from my very limited experience with these babies but I
do have concerns about the message we are giving to mothers about the
adequacy of breast milk when Enfalac or Similac powder is added to the
breast milk. ( Not to mention the other risks of introducing cow's milk to
the baby's system).  Actually this comment was made recently my a mother of
a baby in NICU who had begun to question the value of her own breastmilk if
so much had to be added to it!  Once again the formula industry continues to
exert such a powerful influence in the health care system. Thanks to the
Canadian Pediatric Society the use of banked breast milk is no longer an
option in this country!
Janet Murphy Goodridge RN, MN, IBCLC
St. John's, Newfoundland