Dear Alicia,
I don't work much with premies, but I do have a lot of info stored in my database. The following may help you:
>Paula is at Rush-Presbyterian St. Luke's in Chicago. Paula has a pager 1 800 980 7478 and the number at Rush 312 942 6604. e-mail address: [log in to unmask]
Valentine CJ, Hurst NM, Schanler RJ. Hindmilk improves weight gain in low birth weight infants fed human milk. J Pediatr Gastroentrero Nutr 1994:18:474-77
"since BM is not pasteurized, the fat DOES layer out and stick to tubing. We therefore use small bore (micro-bore) tubing in the shortest length possible and place the syringe pump below the level of the baby with the point up at 45-90 degrees to minimize fat loss."
Raising cream content of milk
I have had mothers increase their fat content of the milk with the use of adding dehydrated green drinks to their diet. One mother ( a lactation consultant, mother of 4 and not eating well had to begin supplementing one ounce of formula per day since her 6 week old infant was losing weight....good output but her milk was bluish not a creamy white. I encouraged her to begin using some form of dehydrated greens (such as barley grass, wheat grass, alfalfa, etc for the high chlorophyll content). She chose the product Kyogreen and used a tablespoon twice a day. Within 2 days her milk changed from the bluish thin type to a creamy white. The infant began to gain 1 ounce per day and she was able to stop the supplement (formula) also within 2 -3 days. She was thrilled. He husband wanted to go on the Kyogreen because it gave his wife so much energy...(he was working 3 jobs so she could stay home with all 4 children).
1 tablespoon of Brewer's yeast once or twice a day is also good at fortifying the breast milk.
The recipe I shared last week on this site~ the "Breastfeeding Health Shake" not only strengthens a mothers immune system but it also helps her to increase her milk content and make a good quality of milk. Here is the recipe again:
1 cup yogurt (especially with lactobacillus acidophilus culture added), any flavor
1 Tablespoon Brewers Yeast
1 Tablespoon granulated lecithin
1 scoop (tablespoon) Ultimate Soy Spirulina (or other type of dehydrated green drink)
or 2-3 capsules of alfalfa sprinkled into drink.
1 tablespoon ground flax seeds or flax oil (I prefer ground flax seeds to give her all the lignans possible and it is good fiber for an intestinal sweep).
Favorite fruit.
Blend and enjoy. (Some of my moms who need a special treat to boost their spirits: I encourage them to add a scoop of chocolate ice cream or their favorite flavor. )
"A number of nicu';s use this technique to enable the mother's to privide hindmilk with specific a caloric content to match the need of their infant. This is done as an alternative to using a fortifier
There are a number of articles that discuss this:
Lemons, JA et al: simple clinical technique for determining the caloric and fat content of human milk PEDIATRICS 1980 66:626-628
Lucas A er al: creamoticrit: simple clinical technique for estimating fat concentration and energy value of human milk Br Med J 19781:1018-1020
Polberger S ert al : simple and rapid macronutrient analysis of human milk for individual fortification: Basis for improved nutritional management of very low birth weight infant J Paedric Gastroenterol Nutr 1993 17: 283-290
Silprasert A et alL effect of storage on the creamatocrit and total energy content of human milk. Hun Nutr Clin nutr 1987:41 31-36
Creamatocrit 3 4 5 6 7 8 9
Gr of Fat/ml 0.012 0.023 0.03 0.037 0.044 0.051 0.058
Cal/ml 0.49 0.56 0.62 0.69 0.76 0.82 0.89
Cal/oz 15.7 17.8 20 22.1 24.3 26,4 28.5
% of Cal-fat 22 37 44 48.2 52.1 56 58.2
CREAMATOCRIT 10 11 12
Gr. of fat/ml 0.064 0.071 0.078
Cal/ml 0.96 1.02 1.09
Cal/oz 30.7 32.8 34.9
% of Cal - fat 60.4 62.6 64
This all is based on regression equations in Lucas, Gibbs, Lyster, & Baum. Creamatocret: Simple Clinical Technique for Estimating Fat Concentration and Energy Value of Human Milk. BRMJ 1978; 1:1018-1020 This is Paula Meirers info so if you use it, please give her credit.
Modification of breastmilk also can result in faster growth rates. For example, using hind milk has resulted in faster growth. Ultrasound homogenization results in less fat sticking to tubes.
Where the mother was expressing/pumping more than her baby needed, they got her to keep a log for a couple of days of how much she typically expressed at each session, noting the time of day. If her 24 hr production was, say one-third in excess of what her baby needed, then at each session she put aside the first third of what she expected to express/pump and then kept the next two-thirds to be fed to her baby. Obviously there would be some need for adjustment, but you should get the idea.
Simply, this meant the baby was getting the second portion of the milk. Probably more fats, but more of what other nutrients? She said that the babies did particularly well on this regime and did not
need fortifiers.
We have been having mothers number their bottles of milk for the first 30 pumpings and we use them in order for the first five days after feedings are started. After that, we have mothers fractionate their
milk into foremilk (first 1/3 of the pumping) and hindmilk (last 2/3 of the pumping) and give fresh, never-frozen hindmilk for approximately 2 weeks, or until weight gain is optimal. This is not my idea, it is
Dr. Paula Meier's from Rush-Presbyterian St. Luke's in Chicago. Since we have been doing this, we have had less trouble with high residuals, and terrific weight gain. Paula says that they are able to
approximate intrauterine growth levels using this method, and I can believe it.<
The previous info is taken from different posts over the last few years. If your mom is pumping lots of milk, I would think that using the hindmilk only for a while might be a good first step - save the first part of the pumping separate from the second part and use the second part only for now. Spinning down the milk to concentrate the fats could be added to the regimen if the hindmilk only doesn't do the trick. Mom might also want to add breast compressions while she is pumping the hindmilk to possibly increase fat content even more.
Hope this helps. Good luck.
Warmly,
Sharon Knorr, BSMT, ASCP, IBCLC
Newark, NY (near Rochester on Lake Ontario)
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