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From:
Rachel Myr <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Sun, 26 Jan 2003 20:55:00 +0100
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Welcome back to Lactnet, Lisa, and congratulations on your new arrival.
I am not a specialist on premies.  But I spent some time with one of the
other IBCLCs in Norway last week who is a specialist on NICU babies and
asked what the guidelines are in Norway for use of human milk fortifiers.
(If any of you have seen 'Breast is best', she is in it, in the scene with
the 30-weeker going to the breast.)
Here, babies with birthweights under 1200 g are given fortifiers, both
protein and fat.  Babies whose mothers don't have enough milk are given
banked human milk, with the smallest and least mature babies being given
priority if it is scarce.  Birthweight is the only criterion, not
gestational age.  The fortifier is not stopped before the babies are
gaining, though I don't know that there is an absolute limit for when they
stop.  There is much discussion at the moment among neonatologists about
increasing the weight limit where they recommend fortification of
breastmilk, and increasing the length of time they are given it, because our
babies don't grow as fast as babies where fortification is more widespread.
I didn't get a chance to ask whether there are other lags in these babies
compared to premature babies in other countries, nor whether anyone has
considered the idea that the most rapid growth may not always be the best
thing for a person.

From your post it sounds like your baby is doing very well so far and is
being treated the way we would treat such a baby, with early PO feeds of
mother's milk, then breast and gavage.  I don't have at my fingertips what
our guidelines are for some of the other minerals.  In the hospital where I
work, all babies under 2500 g are to be given a commercial multivitamin
supplement including folic acid from day 3, and iron supplementation begins
for these same babies at 6 weeks, I think.  I have mentioned before that the
cod liver oil lobby is quite powerful here, and the official recommendation
is that every person, of every age, take one teaspoonful of purified cod
liver oil daily from the age of 6 weeks, for the rest of their lives.  The
main brand has some vitamin E added as an antioxidant, and supplies vits. A
and D in standardized amounts.  These vitamins are not present in large
amounts in the other supplements.

Rachel Myr
Kristiansand, Norway

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