Valerie:
There is a great deal of research on the nutritional needs of preterm
infants, and on the changes in human milk, including preterm milk, over time.
 Although mothers who deliver preterm have milk that is richer in protein,
sodium, immunoglobulins and several other factors, the milk changes over time
- and changes much faster than the nutritional needs of the very low birth
weight infant.  There is ample research, some of it quite old, showing
preterm infants grow better with fortifiers.

There is some information from Germany that if you push total intakes to very
high levels (much higher than ANY neonatologist in the US would go- 300-400
cc/kg/day) some preterm infants will grow without fortifiers, but as PDAs and
chronic lung disease increase with increased fluid intake, we will not go
that route.

We are aware that fortifiers are not harmless - that they change the milk in
ways we may not know at present, but the alternative (preterm formulas alone)
is much worse. Ideally we would like the add mother's own
dessicated/fractionated breastmilk as a powder back to her own liquid milk as
a fortifier.  Someday we will.  But for today, we will do all we can as
Neonatologists to support breastfeeding AND provide the best nutrition using
available research.
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

             ***********************************************
The LACTNET mailing list is powered by L-Soft's renowned
LISTSERV(R) list management software together with L-Soft's LSMTP(TM)
mailer for lightning fast mail delivery. For more information, go to:
http://www.lsoft.com/LISTSERV-powered.html