Dear all:

I am speechless.  There is a body of literature on how messing with formula concentrations can lead to hypernatremia.  It is beyond me, why, with no evidence to back this, scoops of formula are being added to breastmilk just because a mother may not want to give formula.  Just because it is more calorically dense doesn't mean that she is not giving exactly the same amount of formula solids, it just means that there is less water which is not as good for the baby's kidneys.  Similarly for overdilution.  Furthermore there is a whole body of literature showing how even highly intelligent parents make mistakes when mixing formula, so I personallly never recommend it myself.  When it comes to premature infants and the additional minerals they need -- I am completely out of my depth and don't touch that situation with a 10 foot pole. 

Furthermore, the FDA recommends against using powdered formula in the first 21 days of life --- due to the possibility of ESak.  Given the choice of sterile formula versus unsterile formula, I would chose the later -- and so would most parents if it explained to them.

To leave a parent thinking they are giving LESS formula just because it is in a more concentrated powder is not what I would call informed consent.

Sincerely,
Susan E. Burger, MHS, PhD, IBCLC

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