Dr. Wight,
I apologize if you or anyone else took offense. The quote below was written
by me, not Marsha. You are right, I'm neither a neonatologist nor a
dietician. However I worked 12 yrs in a regional NICU as a head nurse and
now count 28 yrs in either peds, nicu, or lactation working with premie
babies. In my experience, the excellent care that you provide, using the
available best evidence and follow-up, and involvement in neonatology and in
breastfeeding medicine, is NOT typical of care that all premies receive. I
see and hear with my own eyes and ears what goes on in the care of premature
or otherwise sick babies, and I am often amazed and upset. And I see and
hear the influence of the formula marketers. Here's a real example: a baby
being fed, say 25 mls every 3 hrs, doing very well but not gaining. I have
seen over and over again that just getting to the proper volume (in absence
of any need for fluid restriction) will get the proper calories and wt gain
going. Instead the doctor decided lets use the premie formula (22 cal/oz) to
give more calories to the baby (same 25 mls). This would provide about 13 or
14 extra calories each day!
Please note that I stated "practitioners" and not neonatologists, as I have
worked with many general pediatricians and family docs, who sadly, are not
well informed of the issues, but yet continue to manage premature infants. I
hate to get started on a bashing thread, however it is just a fact of life
that lots of these babies are not receiving optimal care and follow-up. I'm
sure working in your unit would be close to Nirvana! And I'm not being cute.
I think I also said in that post that this issue has been archived and there
are pros and cons to use of the fortifiers. I'm not saying what side is
right, however I think I recall some posts on liberalizing volume for "well"
premies or "feeders and growers" as we call them, giving more than the usual
mls/kg with good outcomes. Again, my apologies.
<<"I beleive that practitioners who use this additive, especially with later
date premies like
32+ wks, are not well read about the proper use and are getting most of
their info from the formula sales people. (my opinion). I also beleive that
these same practitioners are not well experienced with bf + premies and just
don't trust that bf or even ebm will properly nourish the babies.">>
Laurie Wheeler, RN, MN, IBCLC
MISSISSIPPI USA and formerly, New Orleans
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