I need some expert advice about an infant in our NICU.  Sophie was born about
3 weeks ago at maybe 34 weeks SGA.  Was diagnosed with Dandy Walker Cyst, has
a small hole in soft palate, a PDA which has sinced closed with medication.
 I got a call from her mother this morning with the news that they have just
discovered a VSD.  Attempts to nipple feed have not been successful--15 cc's
tops.  She is gavage fed with EBM and fortifier--4 packets in 50 cc of milk
plus MCT oil. Is on diuretics, lanoxin, etc and a fluid restriction of 38 cc
q 3 hours.  Sophie's mother has a very good supply of breast milk.  She pumps
at least 4 1/2  oz. several times a day and 8 oz twice each day in the am.
 While she's at the hospital, she has been discarding the first oz. and using
the rest.   She was recently told by one of the neonatologists that she would
"never" breastfeed. She said that this was because of the need for
fortification and fluid restricitons.  Surgery will be done at  10 pounds.
 Sophie now weighs close to 5 lbs.
Sohie's mom is now pondering her options.  She has investigated the cost of
27 calorie formula.  I think I convinced her with little trouble that
breastmilk would be best for Sophie.  She describes the fortified milk as
very thick and says Sophie cries after she is fed.  She wanted to know if it
was true that she never could breastfeed and if she was to continue pumping,
if a purchased pump would be adequate ( I think she is considering a Nurture
III type pump).
My questions to you are these.
1.  What could be done with Sophie's mothers milk to fortify, since she has
such a good supply.  I know there are references somewhere on fortifying with
hind milk.  Is this adequate with a baby with cardiac defects?  Should we try
to decrease her supply?
2.  If we can talk the neo into more attempts at the breast with an SNS
--does anyone have any tips on its use in a similar case?  Also what would be
recommended as far as a progression goes--practice sessions on an empty
breast?  etc.
3.  Since this mother has such a good let down and supply, would it be ok to
go with a purchased pump if we are looking at long term pumping?

I am anxiously waiting replies---I think LACTNET great!

Chris Lundberg
Indianapolis, IN