Human milk fortifiers are absolutely unknown in Zimbabwe.  Nor have I ever
known of any lacto-engineering where mothers might be encouraged to skim off
the cream and add it to EBM to add to the calories.  The tiniest babies I
have ever worked with were 600 and 700g born at 25 weeks. They left the NNU
exclusively breastfed at 100 days (that's 39 weeks CGA) and their mom had
provided unmodified EBM (straight, as it comes) for them from the time they
could take anything via NGT until they were breastfeeding well. The ELBW
babies are given very tiny quantities in the beginning, but once their
condition has stabilized I do notice that they receive ever-increasing
amounts - up to 280 ml/kg/day, yes - and may gain 60 - 75g per day shortly
before discharge home at 1800g, exclusively breastfed.

When I read about HMF being used in other countries I often wonder about the
risk of sensitivity/allergy following exposure of these very immature
intestinal mucosae to human milk fortifiers (really cow's milk based
supplements) vs the more conservative view of not exposing these tiny babies
unnecessarily to foreign allergens.  I wonder how the research apparently
shows that HMF causes babies to "grow better" (gain weight faster?) when our
pre-term babies obviously thrive and grow without it.

Pamela Morrison IBCLC, Zimbabwe


>There is ample research, some of it quite old, showing
>preterm infants grow better with fortifiers.

>There is some information from Germany that if you push total intakes to very
>high levels (much higher than ANY neonatologist in the US would go- 300-400
>cc/kg/day) some preterm infants will grow without fortifiers, but as PDAs and
>chronic lung disease increase with increased fluid intake, we will not go
>that route.

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