Barb,
Regarding your question on fortifiers for preemies...

1) We use HMF only when the baby is very premature (<34 weeks); for
those babies with a greater GA, we may just go ahead and start Neosure
(or Enfacare) to fortify.  The HMF has higher levels of Ca & Phos and
more appropriate for a tiny one.  The Neosure/Enfacare has more
appropriate levels for an older/bigger preemie.  Your resident is right
that the HMF is not available outside the hospital...the other is (plus
less expensive).
2) Hopefully the above answers this question.
3) YES!  There are safety concerns with using powdered formulas in sick
infants.  You must be very careful when using powder in bulk, like the
Neosure and Enfacare.  The way we do it is premeasure these powders in
the formula prep room in amounts that are needed for each individual
feeding.  The thing you don't want to do is to mix the milk in an open
environment and scoop out of the can all day long.  This is just asking
bacteria in!  Careful preparation is definately a MUST!  The HMF as you
know comes already prepackaged for individual feedings so is not as high
of a risk for contamination.
4) There are references in the literature on fortification of feeds for
infants, but I am not in my office right now to give you specifics.  Do
you have a neonatal dietitian on staff?  If so, she would be able to
provide you with references.  Also, I would strongly suggest you obtain
the new reference from the American Dietetic Association (ADA) on the
Preparation of Infant Feedings in the Hospital Setting.

Make sure you get the dietitian involved to help with fortification.
She would be a wonderful and necessary resource for the unit!  Good
luck!

Date:    Fri, 23 Jul 2004 09:37:55 -0400
From:    Barb Fibich <[log in to unmask]>
Subject: A question for the NICU lactnetters

I have a question for the neonatology wise ones.  I'm an RN IBCLC at a
birth center with a level II nursery.  We just expanded our unit and
are
now seeing more near term and preterm babies than we did before.  This
is
foreign territory for me.  My question is about human milk fortifiers.
The
few times in the past that we had babies getting fortified milk, we
were
able to just send them home with enough fortifier to finish out thier
course.  Now that option will be much more expensive.

Our resident physician told me that the NICU where she covers starts
their
preemies out on human milk fortifier (HMF) and then transitions them
to
Neosure powder as a fortifier prior to discharge.  The rationale for
the
neosure powder is that the parents can find it at Walgreens whereas the
HMF
is not available at local pharmacies and can only be purchased from
the
company by the case, which means they have to buy a lot more than they
need.

What I'm wondering is:
1) What is the rationale for starting with the HMF vs the neosure?
2) Is there a gestational age where it would be OK to start with the
neosure and forget the HMF altogether?
3) Aren't there concerns about bacterial contamination and powdered
formula?  Is it safe to be using it at all?
4) Can anyone point me to some references about the use of HMF that I
could
use to improve my scant knowledge base?

Thanks!

Barb Fibich, RN, IBCLC
Feeling overwhelmed in Milwaukee

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------------------------------

End of LACTNET Digest - 22 Jul 2004 to 23 Jul 2004 - Special issue
(#2004-956)
******************************************************************************

Ginger Carney, RD, LDN, IBCLC
Clinical Nutriiton Mgr./Lactation Consultant
Le Bonheur Children's Medical Center
Memphis, TN
[log in to unmask]

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