I would start the infant on mom's own milk without any HMF added. We
frequently see feeding intolerances in premies when HMF is added. If her milk supply
is at least 1/3 more than what he is taking, she could also provide hindmilk
to increase the caloric density. We recently had a premie transfer from another
NICU in town for feeding intolerances. Everytime they got him to full feeds
and added HMF he blew up his belly and had residuals. This mom was committed to
breastfeeding as she had breastfed her 3 previous children. We got him
started on small amts of EBM, then increased to full feeds with nothing added.
Afterwards we started hindmilk feeds which he did for about 6 weeks before being
discharged home exclusively breastfeeding. Neo RDs kept track of all the
nutrition stuff as well as the labs necessary to watch bone mineralization. I would
bet that this baby has an intolerance to the cow's milk protein in the HMF. If
he still reacts to mom's own milk, then ask her to go dairy free for 2 weeks
then try her milk again. You can also purchase dairy free donor milk from some
of the milk banks. Good luck.
Chris Smith, RN, IBCLC, RLC

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