from RCH Victoria (Royal Canadian Hospital?) Neonatal Handbook:

http://www.rch.org.au/nets/handbook/index.cfm?doc_id=907  :

<<In general infants with a birthweight less than 1500g and less than 30 weeks gestation will benefit from addition of fortifier. Breastmilk fortification is often commenced at half strength for 2 days and if tolerated full strength supplementation is introduced. However, there are a number of potential complications with fortification. These include:

 *

an increase in regurgitation

 *

an increase in feed intolerance

 *

glycosuria in extremely of preterm infants

 *

hypercalcemia in extremely preterm infants

The growth of infants fed fortified breastmilk is still less than infants fed on preterm formula. However the quality of the milk and its many advantages far outweigh any growth disadvantage. In general, fortifier can be discontinued once the infant reaches a corrected age of term and prior to discharge from hospital.>>



To answer your questions 1. is it ever a case by case basis that premies need HMF or is it an "always this early" kind of thing?

I think in USA, they would say it is always needed for this baby's size and GA. Sounds like this baby was around 1200 grams and 30wks,

so fits criteria above. (also note, baby is at higher risk for NEC with a PDA, I believe). Not sure what criteria in USA vs Canada, couldn't easily find it when I searched. HMF use not so in all areas of the world.

2. would it be responsible to support mom in requesting no HMF at all if they won't give human milk -based?   My biggest concern is that

mother's concerns and desires seem to get ignored. I suggest that she ask for a conference and include the ethics team. I don't see

why the parents cannot refuse the treatment and search for options, and then of course the nicu can get a court order to give the treatment. (Have seen this done

when dr's felt baby needed a blood transfusion). However, I don't think it would come to that. But rather, the staff would have to brainstorm

and see what would be best for baby. And/or the dr's would have to show parents why the fortifier is truly needed (i.e. baby's labs).

Surely the HMF could be stopped to see if baby begins tolerating feeds again. Possibly the baby would tolerate every 2nd or 3rd feeding

with HMF if the minerals are truly needed. Possibly just the minerals could be given, following labs; is baby still on any IV's? There is also another fortifier

that is liquid and not powder. 3. is there anything else mom can say or do to convince the hospital toward the human milk HMF? I don't think

they will use this based on cost. 4. how long do babies w/ these circumstances typically require HMF? see above.

Hope this helps some,

Laurie Wheeler RN MN IBCLC

Mississippi USA





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

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