Carol wrote, "Is there an alternative to HMF, that these NICUs &
neonatologists/nurses aren't aware of? Our task force waits with baited
(non-milk!) breath for your collective words of wisdom!"

When Ros Escott was here for a wonderful visit, we took her to have a look
around the maternity units at two hospitals (one government, one private)
and their Neonatal Units.  At the private hospital she asked the Sister in
the NNU if they use Human Milk Fortifier.  The Sister did not understand the
question!  Mainly because she has never seen any (nor have I for that
matter!)  Prem babies, even very low birth-weight prems (the smallest I have
worked with have been 600g and 700g twins) are fed nothing but their own
mothers' milk - and as it comes, i e no special techniques to give only the
hindmilk. If these babies are well enough to be fed anything before the
mothers' milk becomes more plentiful they are given ordinary (powdered)
formula for 2 - 3 days.  However, usually the very tiny, very sick babies
are on a drip for the first few days so this situation frequently doesn't
arise for them. Once their mothers are able to provide EBM the only
supplements they have are Vit D.  Iron may be given later, but not usually
in the NNU.

"What if HMF is NOT used, & the kids develop bone deficiencies, failure to
thrive, or whatever?"  They don't!  If they are not gaining on mother's milk
then the paediatricians seem to look for other causes (infections, medical
conditions) and are just very patient.  The protocol for one of the
paediatricians, for well babies, is to feed 150 ml/kg/day from the 5 - 10
days, then 180 ml/kg/day from 10 - 14 days, then 200 ml/kg/day thereafter.
Sometimes the intake has to be reduced if a baby's condition deteriorates,
but then increase again as he improves.  Eventually the weight starts
creeping on slowly and then at a faster rate, and so on.  It *can* be done!
Best wishes.

Pamela Morrison IBCLC, Zimbabwe



Carol in St. Louis