I have not been part of this discussion, but wanted to give you a "heads up" that:
1. we should NOT tell parents to go against MD instructions - we can encourage them to call to clarify the instructions, and explain our concerns.
2. I know personally of VERY supportive MD's who instruct parents to mix formula with breast milk for babies who are being discharged from NICU and need the extra calories (usually this is done for SOME not all the feeds, as breastfeeding is still encouraged).
3. The cost of the breast milk fortifiers, along with their unavailability (a mom with twins called me in a panic after driving for over 3 hours trying to find it) has led many doctors to use this method to increase caloric intake.


Jeanette Panchula, RN, PHN, IBCLC
Vacaville, CA, USA

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