I am an RN/IBCLC in a NICU; I have a patient that was born prematurely at
31 wks gestation, now at 35 wks adjusted age.  The infant has been feeding
expressed breastmilk for several weeks with human milk fortifier added to
yield 24cal/oz.  The infant suddenly developed abdominal distention which
xrays revealed was due to extreme presence of gas. The infant was made NPO
for 24hr, a OG tube inserted to remove gas, and restarted on feedings of
lactofree as the mother has hx of lactose intolerance. The infant is tol
feeds well and has been instructed to no longer express milk for baby as
he will not be able to have it.  There was some discussion of adding
lactaid drops to the ebm but we were told it could only be ordered from
Canada therefore would not be something the hospital could order(?). I was
wondering if OTC lactaid caplets crushed could be added to the milk
and "lactofree" abm could be added to the ebm to make 24cal/oz or even
better, add MCT oil or canola oil to give more calories to the infant.
Would it help if she gave hindmilk only to the baby so no additives would
be needed and the infant would have the milk in the stomach and small
intestine longer to facilitate the production of lactose consuming
enzymes? I really hate that she's been told not to five ebm. And the neo
says putting baby to breast out of question and he would get too much
lactose!

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