I wrote recently asking about human milk fortifier and why it was being used
for premies post discharge in our area.  We work in a special childrens
clinic and see many premies after discharge.  Not surprisingly, there was
agreement about the inappropriate use of HMF outside the ICN.
 We (LC and Nutritionists) spoke with the pediatric GI (who was making the
recommnedations) about this and he stated he supports breastfeeding and has
seen an increase of premies getting breastmilk.  However, he feels that "the
preterm infants greatest nutrient needs are at hospital discharge."  (This is
a Similac NeoCare advertisement!)  He feels the breastfed infant needs more
protein, calcium and phosphate as opposed to the polycose, MCT oil route we
usually take when they are not gaining well.   (I can hear Dr. Jack, ask him
to show us the research that supports this!)  His challenge is, then we need
to recommend something to meet the Calcium Phosphate and protein supplement
similiar to HMF for the babies.
 This Dr. follows these very sick babies until things are resolved.  He is
very faithful.  However, he does not understand breastmilk and is not the
easiest to educate.
 The question:  What are the benefits to the breastfed infant to receive this
increase in these areas, and what are the documented risks. (Renal solute
load is one).  Riordan and Auerbach speak to this area briefly but the
research is 1985.
Thanks again,
Robin Hollen RN IBCLC
Reno, Nevada