Lynn and group,
I was some what surprised to read about the discharge home of preterm
infants on HMF (human milk fortifier).
I have worked in various NICU's over the last 25 yrs and have seen very
little use of HMF 2-3 weeks before discharge.
I have seldom seen high calorie formula used either. Many of the AF fed
infants do go home on 22 calorie formula,
for approx. 2-4 weeks depending on their needs, but if mom has been feeding
EBM, and at some time
during hospitalization was on HMF, the infants were weaned to straight EBM
long before discharge.
I do not know if this is just a practice in our area/unit or if this is a
common practice but I have worked on the
East coast and Deep South over the last 10 years and this is the pattern
used here.
There has been the RARE case where the infant had some EXTREME nutritional
need and remained on 24-27 calorie
fortified breastmilk along with other nutritional supplements due to a
genetic anomaly. But even this child was d/c'ed home
on straight EBM but with medications to be added. The one case I can call
upon was of a discordant twin
with a sever congenital heart problem (post operative), intestinal
absorption and impaired growth (hormonal ??)problem.
I am not sure what the final diagnosis was from the genetic studies. The
other twin was double the size at birth, no apparent
anomalies, and breastfed (direct) at discharge and gained weight accordingly
(13 pound when the other twin was 3lbs-8oz).
From my experience HMF has never been sent home with family. We are a
little slower getting to breast but have had good
success with many of our preemies. Some gestations as early as 23-24 weeks
at birth.
I look forward to hearing more about this topic. I have just resumed
reading LACTNET after taking a sabbatical to
study for the IBCLC exam. I passed!! I really look forward to reading
this site, as it is so packed with topics and from
a variety of locations and countries.
Ann Slaughter RNC, IBCLC
Alabama
-------------------------------------------------
> Date: Tue, 15 Oct 2002 12:20:23 EDT
> From: Lynn Shea <[log in to unmask]>
> Subject: Re: Lyla's premie
>
> Lyla writes;
> >>i have read everything i could find in the archives and elsewhere re:
the
> controversy about human milk fortifier - i realize this was just discussed
> in July. However, I just received a call from a mom of a 34 week premie,
> now 3 weeks post-delivery. i have no details except baby just came home,
> is on fortifier mixed with ebm, is constipated (true pellets, not just
long
> intervals) and mom wants to know if she must continue fortifier. baby
born
> at 4#7oz, and at 3 weeks weighed 5#4oz.
> i
> couldn't find anything in the archives about whether fortifier is *ever*
> necessary with a baby this age/size. is it a protien issue at this size
as
> well, or just an energy/calorie issue. would lacto-engineering and
perhaps
> an appropriate vitamin suffice? i read all the posts by nancy wight and
> others - very helpful and intersting, but none address this
> age/size. suggestions?<<
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