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?<<

Lyla, You have raised some great questions here and you are right in your
assessment of Dr. Wight's posts. She speaks to the use of enhanced cal/
premie disch formulas in very general terms, and in regards to its use
findings via research.
That is, research seems to suggest that premies fed fortified EBM after d/c
have better growth and better head growth. While certainly important, this
research is limited in many areas not the least of which is the quality of
the group deemed "breastfed" and compared to the enhanced cal group. Simply
assigning a group as such does not speak to the quality of the breastfeeding.
We know that this premie population presents unique challenges to the
initiation and maintanence of effective breastfeeding but in no way is this
variable allowed for in the studies. What needs to be done is a study of a *
well supported * premie cohort as compared to the former.
At any rate, the fact remains that more and more former premies are d/c'd
having brfed even less than in previous years (gotta keep those calories
up!), parents are more and more reticent to waste precious tummy room on the
inferior calorie "straight" brmilk offered via the breast and pediatricians
are reluctant to increase the freq of feedings at breast  as quickly  as in
the past because of a fear of sacrificing the growth. Where is the fear of
sacrificing the breastfeeding ?
"Practically" speaking, you are asking for help with this particular
diad.......I have also found that very often constipation or stooling
difficulty is an issue with enhanced cal EBM fds. This leads to an important
part of the clinical pix and one that you didn't mention -how is the baby
feeding at breast? IF he is doing well, I MIGHT make the jump to breast only
during day and breast followed by suppmt'd EBM at night (with close f/u).
This should cure the stooling issue but still offer some extra cals as a
transition to full brfdng. UN fortunately this idea is often met by great
resistance from the pediat and or family but when all agree, works well!
Good Luck!

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