Dear Lactnetters,

There seems to be a misconception out there that all preterm infants
require human milk fortification:

"A question was posed about the routine fortification of all preterm
infant's mothers' milk.  Hopefully the following references will help to
stop this practice!"

This is not the case and is not recommended.

The optimal food for preterm infants is maternal milk, in most cases
unfortified.

Under 1800 grams there are ***undoubtedly** problems with a large variety
of nutrients that need to be addressed.  The problem is more acute with
infants less than 1250 grams.  These problems include:

-Metabolic bone disease and fractures due to phosphate deficiency.
-Cardiac failure and chronic lung disease associated with fluid overload.
-Iron deficiency due to the low iron stores in a small infant.
-Excessive loss of electrolytes due to renal immaturity.

I have worked in NICU's prior to the days of fortification and am aware of
the nutritional damage that very low birthweight infants suffered from lack
of nutrients in breastmilk.  I have seen rib and femur fractures from
parents and nurses routinely handling babies.  We have unfortunately
drifted too far in the opposite direction, such that I have seen infants
with critical electrolyte levels from inappropriate use of fortification.

The aim of fortifier is to address these problems.  It should be considered
a medication with specific indications and side-effects as with any other
drug.  It should be prescribed by someone who is aware of the indications.
It is expensive and when used liberally gives mothers the false impression
that their milk is inadequate.

The use of fortifier over 1800 grams should be resisted (as stated by the
CPS) as it may lead to excessive intake of calcium, phosphate, etc.

The references quoted in the last posting will support all the above.

Khalid

Khalid Aziz
Memorial University of Newfoundland