For healthy term infants, adding powdered formula to human milk is  
unacceptable.  The problem, as you all have said, is increasing human milk  intake, 
not increasing calories. 
 
That said, very low birth weight babies in the US will often need the added 
 protein, calcium and phosphorus that follow-up artificial milks provide, 
as  they are discharged before term and with accumulated nutritional  
deficits.  There is ample research that long-term neurodevelopmental  outcome is 
tightly linked with early infant growth.  That is why we provide  immediate 
parenteral nutrition and early fortified human milk for our smallest  infants. 
 
 
We add powdered infant formula (or recommend reconstituted liquid formula  
if the parents wish to give 1-3 feedings per day of only formula, instead of 
 mixing) shortly before and after discharge for the added protein, calcium 
and  phosphorus, NOT for calories, if the infant is unable to take enough 
human milk  to get the needed protein. Yes, adding anything (except human 
milk-derived  products) to human milk causes increased bacterial growth (of the 
bacteria  already in the milk) and does change the immunologic potential of 
the milk  somewhat.  
 
I would love to use only human milk products, and we are all working  
towards that.  Unfortunately, not all mothers of preterm and ill infants  are 
able to establish and maintain an ample milk supply, despite all the help we  
can give.  Until we change the very fabric of US society (maternity leave,  
etc.) we will continue to have problems.  
 
Nancy
Nancy E. Wight MD, IBCLC, FABM, FAAP
Neonatologist, San  Diego Neonatology, Inc.
Medical Director, Sharp HealthCare Lactation  Services
Sharp Mary Birch Hospital for Women and  Newborns

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