Holly:
Hate to break it to you, but the approach you outlined is a reasonable
approach given current nutrition research.  I usually start fortifier as
soon
as I reach 50-75% enteral feeds in any baby < 1800 gms.  I realize that
elsewhere in the world they push fluid volumes up to 250-300 cc/kg/d to
increase needed nutrients to VLBW infants without adding fortifier. They
claim not to have more PDAs or CLD. You cannot achieve the needed protein,
calcium or phosphorus amounts with the fluid volumes that are considered
"standard of care" in the USA, without fortification of some sort.  Richard
Schanler is the most rigorous, intellectually honest NICU nutrition
researcher I know, AND an avid breastfeeding supporter in the NICU (past
president of Academy of Breastfeeding Medicine and current Pres. of ISRHML).
Look at his articles, including most recent review in Pediatric Clinics of
North America, Feb 2001; 48(1): 207.
Nancy
Nancy E. Wight MD, FAAP, IBCLC
Neonatologist, Children's Hospital, and Sharp Mary Birch Hospital for Women
Medical Director, Lactation Services, Sharp HealthCare
San Diego, CA, USA

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