I believe we have discussed, and I have commented on this before. Briefly
this is a hotbed of controversy. Lucas's and others' data strongly suggest
that infants will grow better and have better bone mineral density if given
extra protein, calcium and phosphorus for months to a year post-discharge,
depending on their initial gestational age and birthweight. However, by 5-8
years of age the bone mineral density in breastfed infants "catches up"
although in some studies the infants remain 1 cm shorter. Theoretically, and
with some well-done studies, mature breastmilk does not provide enough
proetin, calcium and phosphorus for the "catch-up" growth these infants need.
On the other hand, there is also evidence that early malnutrition is
associated with better/lower blood pressures and less obesity later on.
The answer is not in. We are all concerned about "adulterating" mom's
breastmilk with fortifiers, but we also want to see optimal growth and brain
development. I have to keep reminding myself that premature infants were
never MEANT to survive, and that what we are doing is very unphysiologic,
whether we are using breastmilk or the other fake stuff.
I have my neonatal dietitician calculate the amount of protein, calcium and
phosphorus a given baby should need, check growth labs such as calcium,
phosphorus, alkaline phosphase, BUN, creatinine, pre-albumin, and see if the
needs can be/are met with breastmilk exclusively. If not, we have mom give
1-3 supplemental feedings per 24 hrs (by the method of her choice) of NeoSure
or Enfacare to get the needed nutrients or use the powders added into mom's
breastmilk. We try to keep most of the feedings unencumbered at the breast.
I find mom's will not stick with an SNS very long - very cumbersome and hard
to clean.
Nancy
Nancy E. Wight MD, FAAP, IBCLC
Neonatologist, Children's Hospital and Sharp Mary Birch Hospital for Women
Medical Director, Lactation Services, Sharp HealthCare
San Diego, CA, USA
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