Nuria and Lisa
This is very interesting to me.
The LBW babies I've worked with (in Zimbabwe) received exclusive
breastmilk-feeding and then received extra calcium and Vit D as extra
separate medications. And later, extra iron as well. But Human milk
fortifier was unknown. The babies were fed increasing quantities of
breastmilk in a careful way and they gained extremely well and were
discharged from the NICUs either exclusively breastfeeding or
exclusively breastmilk-fed by cup (bottles were not allowed...).
Looking (with much interest!) at the UCSD SPIN feeding advancement
tables, I see that the quantities of breastmilk are a lot lower than
what I'm used to, eg feeding a baby born at 1500g only 50ml/kg/day by
5 days of age (I would be used to 150ml/kg/day at this age, if the
baby was stable) and then starting on HMF at 8 days (no doubt to
boost the baby's caloric intake?) and also expecting only a gain of
only 15g/day.
In the NICUs in which I used to work with the mothers of prem babies,
the expected rate of gain for babies under 1500g was 20g/day, and for
the bigger ones we would be expecting a gain of at least 30g/day by
the time the baby was discharged home at 1800g. But the quantity of
EBM that the baby would receive at 10 days of age was 180ml/kg/day
and would increase to as much as 280ml/kg/day when all the
neonatologist was waiting for was for the baby to gain sufficient
weight to be discharged. One of the babies I worked with gained
76g/day on mother's milk alone.
So the conclusion I'm reaching from reading these Tables, and from
reading other material about feeding VLBW babies or ELBW babies is
that they are often fed extremely low quantities of breastmilk,
resulting in very low weight gain, thus rationalizing the "need" for
HMF to boost calories/protein/micronutrients. I found a recent paper
authored or co-authored by Paula Meier which suggested that the
babies in her study were only receiving 100ml/kg/day of breastmilk,
to which was added fortifier. The fortifieer seems to be mixed 1:1
with human milk. And yet the WHO guidelines on feeding premature and
low birthweight babies at
http://www.who.int/maternal_child_adolescent/documents/infant_feeding_low_bw/en
suggest, "VLBW infants who are fed mother's own milk or donor human
milk should not routinely be given bovine milk-based humanmilk
fortifier...... VLBW infants who fail to gain weight despite adequate
breastmilk feeding should be given human-milk fortifiers, preferably
those that are human milk based." Thus we come back again to how
much EBM to feed a baby in order for the baby to gain "adequate"
weight. So the quantities set out in the UCSD SPIN feeding
advancement guidelines seem very low to me.
Would anyone care to comment?
Pamela Morrison IBCLC
Rustington, England
----------------------------------------------
Date: Wed, 17 Feb 2016 14:47:25 -0800
From: Nuria solano <[log in to unmask]>
Subject: Re: Supplementation of the preterm infant
Lisa, go to the spin(supporting premature infant nutrition) at the
website of ucsd, you'll find pdf for "nicu" graduate nutrition plan.
The forms are very helpful. Let me know what you think.
Sent from my iPhone
> On Feb 17, 2016, at 5:20 AM, Lisa Bell <[log in to unmask]> wrote:
>
> Our new neonatologist sends all preemies born at 32 weeks or less
home supplementing with 2 bottles of preemie formula a day. He states
these babies need more calcium and magnesium than is provided in
breastmilk for bone mineralization. He has research to back this up
that was given to him by the formula rep. Anyone else doing this in
their NICU? Does anyone know any research that would support
exclusively breastfeeding these babies? If these babies truly need
these nutrients can they be given other ways?
> Thanks,
> Lisa Bell RN, IBCLC
>
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