I have been holding back as this has been discussed many times  before.
 
Neonatologists are learning, slowly, but learning, that human milk is the  
standard of care for ALL infants, not just preterm infants.  They are  
unlearning that faster growth is always better.  Formula and formula  as 
fortifier does give faster growth, primarily because of the additional  protein, 
calcium and phosphorus.  
 
The current evidence says:
-human milk is the standard of care, but may not be sufficient for optimal  
growth and brain development for the VLBW infant. Too slow growth in the 
NICU is  associated with poor brain growth, lower IQ and increased CP
--human milk (even given the difference in "preterm milk") protein is too  
low to support optimal growth and brain development in preterm infants - it 
was  meant for term infants
-Increasing the volume of human milk helps, but is not sufficient for some  
infants 
- the ideal fortifier would be made from human milk, and is available - not 
 perfect and way too expensive at $6.25/mL - so not universally available.
 
I agree that too much fortifier is being used.  Until we have good  
evidence of exactly which babies need it and for how long, docs are reluctant to  
limit the use, for fear of impairing brain growth and long term optimal  
outcome.
 
Nancy
Nancy E. Wight MD, IBCLC, FABM,  FAAP
Neonatologist
Sharp Mary Birch Hospital for Women and Rady Children's  Hospital San Diego
Medical Director, Sharp HealthCare Lactation  Services
San Diego, CA 
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