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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