Hello, everyone:  Since I've been in major lurk mode for months (I haven't
read a single Lactnet post in all that time and I miss all your wisdom and
experience and humor, etc, etc), I will briefly reintroduce myself before
posing my question.  My name is Alicia Dermer.  I am a family physician and
IBCLC.

Now for my question, which I did try to research on the Lactnet archives with
little success:  I have a personal friend who gave birth to a 29 week
gestation premie about 7-8 weeks ago.  I have not been caring for this baby,
just providing her with breastfeeding information whenever she requests it.
He has been exclusively breastmilk-fed and she has a huge supply.  Baby has
no cardiac or other complications.  However, he is not gaining well.  Because
she has two older kids, she can only get to the hospital to nurse him about
twice a day (he nurses well per this experienced mom).  The rest of the time
he gets bottles of ebm.  He had been getting MCT oil and polycose, but
recently developed very watery yellow stools and the MCT oil was stopped, but
he still isn't gaining (I don't know how his length is, but to the mom he
does look bigger and he also seems to be getting chubbier with more filled in
cheeks).

As you can guess, the neonatologist is very anxious to start human milk
fortifiers, but the baby's father has Type I diabetes, and the family would
like to avoid cow's milk proteins if at all possible.  I remember discussion
of "bioengineering" of human milk by either centrifuging or other method to
feed the "cream" to the baby.  That would at least give extra calories,
although it probably wouldn't give the added calcium that is supposedly
needed.

I tried to locate Paula Meier because I thought they are doing this type of
technique at her hospital, but I couldn't find an e-mail or other address for
her.  At the recent Academy of Breastfeeding Medicine conference, I asked Dr.
Richard Schanler directly and he really had no solution to offer for this
situation.  Does anyone on Lactnet know of someone actually helping mothers
to "enrich" their own milk in a way that avoids using cow's-milk-based
fortifiers?  I need "nitty gritty" advice about how to accomplish, and if
possible some research to back up the practice.Any other types of suggestions
for this mom would also be greatly appreciated.    TIA, Alicia.

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