"Does anyone (hospital) separate the fat from the breast milk and add it to
more breastmilk to increase the calories?"

I haven't done this,  and am eager to hear about anyone who has.  I did have
a baby who failed to gain weight, and when the physician suggested changing
to 24 kcal/oz formula, I asked if we could try to increase the breastmilk
fat content to give at least 24 kcal/oz.  He was agreeable, so I had the mom
pump the first several minutes, put that milk in the freezer, then massage
and pump some more.  I took the milk to the dairy testing center and the
samples came to 24 - 28 kcal/oz.  The baby did gain weight on this expressed
milk and after weight gain was appropriate, baby went back to breastfeeding
and managed to maintain [barely] adequate growth.  The baby had a
chromosomal anomaly, which I can't remember without my notes.  (I've since
moved across country.)

Since chromosomal anomalies can affect the immune system, we were very lucky
that the mom was able and willing to do this.  I am not sure as good results
would be obtained with every mom, but it would make a good research project
for anyone at a land grant university with access to a dairy testing
station.

Arly Helm, MS, IBCLC

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