Netters,
As to the question of fortifying twins who are now 36 weeks. Stephanie
Atkinson
(it may be adkinson) has published a few articles on this subject, her latest
being this spring in Clinics  in Perinatology, where the whole volume was
devouted to associated articles. Even within  a practice, neonatologists may
not agree on this subect. Certainly in our city they don't. Generally, if the
babies were above 1500gms. at birth, average for their gestational age,  and
had a healthy course, some use the standard that they do not need to cont
fortification after discharge. Even if they didn't (ie, weren't aga, were
less than 1500gm, had a sick baby course,- BPD or whatever), many suggest
that they fortify only half of the feeding and cont this until the baby is
3500 grams, about 7 pounds. IF the babies are gaining about 200 gms/week, or
7 oz, this mom wouldn't likely be using this for too long. Fortifiers can be
used to give added protein, calories, and minerals.  It is a chronic
frustration for us when we know that it will be an added burden for these
moms. When neonatologists weigh the risk:benefits, they may come up with
different conclusions about the same babies, b/c the data isn't overwhelming.
We do know that rickets and osteopenia has been identified in some babies who
did not cont fortification, even though studies show that by 5 yrs, bone
density is comparable with fortified and unfortified groups of infants. (One
of our old nutritional researchers said that the window of vulnerability -for
fractures-seems to be the first 6 months.  I wonder where that came from, as
she wasn't also saying to cont fortifying that long. But a comment like that
could make a dr. conclude such.)  We also know that some moms kind of crash
when they go home and can't keep up with it all, are often now paying for
their pump as insurance companies won't always cover after discharge, and
thus wean. That is a huge concern to factor into the risk when looking at
other morbidity, long-term health outcomes.
Once I'm back at the office, I can give you the exact reference if you need
it, email me.)
Warmly,
chris

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