Human milk fortifiers are one of my pet peeves. It is interesting how these
are used in the US as a shotgun approach to providing adequate nutrition to
preemies. These products fulfill what I call a short-term institutional goal -
which is to get the baby discharged as fast as possible. Other stuff is also
used to fulfill this fast discharge goal. I will never forget the telephone
call I received from a mother when I worked for a managed care organization.
She called and asked how best to mix corn oil with breastmilk. The
neonatologist would "let" her breastfeed only if she pumped milk and added
corn oil to it and gave it to the baby in a bottle to make sure the baby
gained weight.

Many NICUs around the world check to see what the baby actually needs and
fortify individual nutrients as needed. Calcium and phosphorus are frequently
needed depending on the gestational age of the baby and his condition. Those
little packets of powdered fortifier are a fast easy way to avoid individual
fortification. There was a notice several years ago of cardiac arythmias being
caused by mixing too many packets into mothers milk less than four weeks
postpartum. Residuals and bowel obstruction are not uncommon side effects.
Fortifiers decrease the immune properties of human milk also.

Why can't we fractionate human milk and use it as a fortifier? The provision
of human milk for preemies is a long-term health and development goal. Brain
and eye development, optimal cognitive performance, exceptional bone
mineralization are what we should be aiming for, not rapid discharge based on
weight. Many preemies are fed so much extra stuff that their weight gain
represents fat not tissue, bone, and organ growth. This fat outcome does not
resemble how the reference fetus grows and gains weight.

Marsha Walker
Weston, MA