Laura writes;
<<Believe me, times are a changin' for our NICU kids as some of you know,
there is no such thing as going home
exclusively brestfeeding if you started out in life a preemie. Nowadays we
send kids home on 2 or 3 bottles of Enfacare (or fortified EBM with
Enfacare powder) because preemies need to catch up with extra protein and
other good stuff. It took me a long time to come to grips with this
latest "findings" that breastmilk is yet again not good enough but in some
ways I can see that preemies are a different population and in the old
days they just didn't survive.<<

There is lots of evidence suggesting that very early premies require more
protein, minerals and calories than most pumped milk provides. There is even
evidence suggesting that now discharged former premies grow better with healthier
bones if given supplemental premie discharge formulas vs. *standard*
breastfeeding. However, a number of essential questions remain to be addressed and
answered.
For the very early premie, can we enhance lactoengineering techniques to
increase calorie content (yes!), or protein/mineral content (?)?
For the hospitalized premie or d/c'd former premie....how do we discern who
*needs* the extra (gestational age at birth? d/c?, weight at birth, d/c?) and
at what *RISK* to the baby's health in the immediate sense (change in gut flora
etc), long term (myriad -many yet to be determined) OR to the success of
breastfeeding (well documented)?
Why are we making decisions based on limited research? eg. I haven't seen a
study that compares premie d/c formulas to the *optimally supported*
breastfeeding dyad BUT I have cared for plenty of them and with optimal support, they
grow terrifically. I would bet that their bones are just fine too!

Lynn Shea Rn,Bsn,Ibclc
Frankin,Massachusetts


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