I realize there are many new people on the list-serve.  Please go back  in 
the archives.
 
In the hospital, it is impossible to get the recommended amounts of  
Protein, Ca and Phos by simply increasing the volume of feeds for very low birth  
weight infants - you would fluid overload them, open the ductus, cause worse 
 chronic lung disease,. etc.  Calories are not the big concern - we can  
always use hindmilk.  Protein is almost always the limiting  nutrient for 
appropriate growth, both in the hospital and after  discharge. Human milk is 
extremely low in protein.
 
We do not use powdered formula as a fortifier in VLBW infants.  We  switch 
to it a few days before the infants go home, if, when our neonatal  
dieticians do the math, the infant is not getting enough Protein, Calcium and  
phosphorus for growth and bone mineralization, or is not growing on human milk  
alone.  The risk of enterobacter sakazakii has been overblown.  In 36  years 
I have never seen a case.
 
Nancy
Nancy E. Wight MD, IBCLC, FABM, FAAP
Neonatologist, San  Diego Neonatology, Inc.
Medical Director, Sharp HealthCare Lactation  Services
8555 Aero Dr. #104
San Diego, CA 92123
858-939-4185  (office)
858-939-4298 (NICU)
858-493-0198 (Pager)
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