I have been holding back as this has been discussed many times before. Neonatologists are learning, slowly, but learning, that human milk is the standard of care for ALL infants, not just preterm infants. They are unlearning that faster growth is always better. Formula and formula as fortifier does give faster growth, primarily because of the additional protein, calcium and phosphorus. The current evidence says: -human milk is the standard of care, but may not be sufficient for optimal growth and brain development for the VLBW infant. Too slow growth in the NICU is associated with poor brain growth, lower IQ and increased CP --human milk (even given the difference in "preterm milk") protein is too low to support optimal growth and brain development in preterm infants - it was meant for term infants -Increasing the volume of human milk helps, but is not sufficient for some infants - the ideal fortifier would be made from human milk, and is available - not perfect and way too expensive at $6.25/mL - so not universally available. I agree that too much fortifier is being used. Until we have good evidence of exactly which babies need it and for how long, docs are reluctant to limit the use, for fear of impairing brain growth and long term optimal outcome. Nancy Nancy E. Wight MD, IBCLC, FABM, FAAP Neonatologist Sharp Mary Birch Hospital for Women and Rady Children's Hospital San Diego Medical Director, Sharp HealthCare Lactation Services San Diego, CA [log in to unmask] (mailto:[log in to unmask]) *********************************************** Archives: http://community.lsoft.com/archives/LACTNET.html To reach list owners: [log in to unmask] Mail all list management commands to: [log in to unmask] COMMANDS: 1. To temporarily stop your subscription write in the body of an email: set lactnet nomail 2. To start it again: set lactnet mail 3. To unsubscribe: unsubscribe lactnet 4. To get a comprehensive list of rules and directions: get lactnet welcome