We have a nutrition task force looking into this now. After reviewing Dr. Richard Schanler, Dr. John Kerner, and Dr. A. Lucas's work we are working on these guidelines for providing supplement for our premies who's lab results show they need more Ca/Phos, or those who are having trouble gaining weight on breast milk alone.
Add powder Human Milk Fortifier When: 1. Mom has enough breast milk.  2. Main concern  of not causing as much interruption of immunities. 3. Not having a problem with metabolic acidosis.
Using high cal Formula 1:1 with breast milk when: 1. we need higher than 24 cal/oz.  2. Mom's production is low.  3. Main concern is weight gain. the breastmilk helps fat absorption.
(Do not mix in advance. The less time they are mixed together the less the immunities are disrupted.)
If only 22cal/oz is needed alternate a breastmilk feeding with a feeding of 24 cal/oz premie formula.

If our rational seems lacking please let us know. We would like to get away with not supplementing at all but at this point it is not an option. We have asked some of the experts how to do this. Poss. liberalize the fluids?

Kim Sweet RN, IBCLC
(I'm at work Jenny and I share a computer)

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