Robin, unfortunately, every "new" thing makes its rounds, thought to be a panacea to all babies' ills.  Just like there is the disease of the month, there is the cure of the month...it takes everyone awhile to realize every regurge is not reflux,   every low wt. gain does not need drastic measures for fixing, and HMF is not the cure-all.

Many HCPs feel helpless if they cannot provide a cure within their scope of practice -- for doctors, this includes being able to prescribe something.
As we help smaller and younger and sicker babies to survive, we have to keep using all our technology and available medicine -- and there, unfortunately, sits Human Milk Fortifier.  In the face of everything we know, for some HCPs, the risks of harm seem less than the  potential benefits.

You and I and our cohorts on Lactnet, of course, would take an opposite stance,  ANY FORMULA IS GUILTY before the fact, and we must prove the efficacy of its use in any given situation.

I am reminded of a cartoon in which an elderly, obviously wealthy woman is sitting in front of a young doctor, with about 20 diplomas and certificates on the wall behind him.  She is saying "Young man, if I were you, with all your degrees, I would be embarassed to say I couldn't find anything wrong with me" [or, my addition] "couldn't prescribe anything for me." 

Chanita, San Francisco

  



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From:   Robin M. Hollen[SMTP:[log in to unmask]]
Sent:   Wednesday, September 24, 1997 9:47 PM
Subject:        Human milk fortifier

     I work as an LC in a Special Childrens Clinic. I am fortunate to work
with a very talented group of dieticians, OT, PT,... who mostly advocate
breastfeeding. I facilitate breastfeeding with a variety of infants with
varying problems.  Lactnet has been invaluable to me.  Now, I need some
perspective about something I think may be a trend here. I am not sure how it
started and am concerned.

     Baby Nicholas, premature 26 weeks, Tracheal Esophageal Fistula, one
kidney, multiple medical problems, G tube.  Discharged at 36 weeks.   Able to
get him to the breast, and he breastfeeds beautifully!  However he requires
 dilation of his esophagus about every 15 days.  Usually his growth slows for
5 days post op so he is fed by G Tube for that time. Goes back to the breast
despite reflux.  Amazing baby and mother!  Well, because he is not gaining
like the charts indicate, aware of his repeated dilations, reflux, the GI MD
put him on human milk fortifier.  The concern about one kidney and his stormy
life were presented and  oil and polycose suggested, but HMF was insisted
upon.

     Baby Austin - 27 week premie, Vancomycin resistant enterococci (VRE),
 Discharged 10 days ago at 40 weeks.    Referred yesterday to us.  All
breastmilk (and HMF in the hospital).   Working with breastfeeding.  Mom
pumps 42 -26 ounces of milk per day.  Baby had reflux in the hospital, but
medications stopped at discharge.  Over ten days post discharge, baby gained
2 ounces.  Pediatrician started HMF.  We suggested adjusting foremilk given
and  treating the reflux so he wouldn't vomit  several ounces per day.

     My question is, is this the norm now to use HMF for growth problems.
 The two seperate doctors told each mom they were trying to stay away from
formula! We pointed out this was formula.  Was there a recent article or
sales job promoting the use of HMF?  Is this just a quick fix?  Is it
indicated?  We (our team) felt there were other approaches.
Please enlighten me.

Robin Hollen RN IBCLC
Reno, Nevada