Ashleigh
I am not familier with the particular brand of human milk fortifier (HMF)
you are using.  Some come in powdered form to be added to expressed breast
milk (which I am used to in Australia and the only form I am familier with)
and other types from my reading I understand come in liquid form and are
mixed with breast milk.  These products contain extra calories, vitamins and
minerals and are cows milk based.  Some brands are hydrolysed to minimise
the risk of cow's milk allergy.
I haven't got the references here but you need to look up the studies by
Robert Schanler who has done extensive research in the area of human milk
fortification.  Preterm babies out of the womb do not grow at the same rate
as in utero if they are fed plain expressed breast milk.  I am the first to
SHOUT that there are huge benefits to ALWAYS give breast milk to premature
babies but there is particular concern about reduced linear growth (length),
head circumference and brain growth. Small premature babies who do not
receive some form of additional supplementation are at a disadvantage in
these areas.  I am aware that some centres perform some form of
lactoenginerring so premature babies receive a higher fat content in their
breast milk with extra supplementation of vitamins and minerals such as
calcium and phosperous that are needed for bone development.  I have no
first hand knowledge of this, but I understand this is a viable option.
However most NICUs and SCNs choose to supplement the expressed breast milk
with human milk fortifier for very good and valid, research based reasons.
Some of the recent research suggests benefits for continuing this
supplementation post discharge but I have some reservations because it means
some feeds have to be expressed breast milk with added HMF and given via an
unnatural means--and may be a factor in earlier weaning. Feeding and
supplementation of premature babies is a complex topic, but when we are
dealing with babies that a few decades ago would have died without modern
intervention, sometimes  unnatural means of feeding (supplemenation with
HMF) is part of the necessary intervention for optimal growth and
development.
Marian Rigney
RN and IBCLC candidate
  Date:    Sun, 14 Jul 2002 06:11:49 -0400
From:    Ashleigh Beyer <[log in to unmask]>
Subject: human milk fortifier (Natural Care)

I believe I may have not made myself clear on my original posting.  Natural
Care is being given in my facility to healthy, term infants as a substitute
to breastmilk. Some of the staff is sending it home with moms who have no
breastfeeding problems.  The moms are not cautioned against the adverse
effects of giving something other than breastmilk to their infants. From
what I understand it should be mixed with breastmilk when there is a volume
issue or may be used with preemies.  What I'm looking for are references
related to the use of this specific product.  I don't think it is being
handled properly in my facility.  If ABM ordered to be given by our
physicians I would rather we use a low iron formula, not human milk
fortifier for our healthy, term infants. References and suggestions greatly
appreciated.
Ashleigh Beyer, RN, CCE, IBCLC candidate 2002





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