I’ve been lurking on Lactnet for about a year now and enjoy it immensely.  I
have a friend in Spokane, Washington with a premature baby in the NICU.  She
is seeking more information on what nutrients baby actually needs at this
point and when she goes home, also how long to supplement.  I’ve tried
searching the archives; perhaps I need practice with that.  
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I have successfully nursed my three sons and am committed to nursing.  I now
have a premature daughter born at 31 weeks 3 days who weighed 4lbs 4oz.  She
is currently 35 weeks 6 days and weighs 6lbs 6ozs.  She is in the NICU
receiving my breastmilk fortified with 24 calorie HMF and gaining typically
between 2.5 and 3.2 ozs per day (80-100g).   We have a known dairy and egg
allergy (2 of my 3 other children) and the HMF contains dairy.  Are there
other substitutes for the HMF, and is it really necessary with her weight
gain? Also, I know she missed out on some important mineralization during
the last trimester.  Could I use a good infant supplement (I believe she
means vitamin drops) to provide the minerals she needs in place of the HMF
now in the hospital, and in place of the dairy formula the NICU expects me
to use as her supplement once I get home?

Here are the nutritional standards for my premature daughter given to me by
the NICU dietician.  I am using these to determine my daughter's nutritional
needs along with a comparison of breastmilk and HMF fortified breastmilk. 
Do these standards look accurate?

Breastmilk:  180mg/kg/day
Calories:      120-130/kg/day
Protein:        3.5-4.0g/kg/day
Calcium:       185-210 mg/kg/day
Phosphorous:  125-140 mg/kg/day

Thank you for your help.
************************
Both of baby’s lungs were punctured after the emergency section at 31 weeks,
baby continues to have ‘periodic’ breathing and oxygen desaturation.  She
apparently needs to stay in the hospital until she has five days with no
periodic breathing whatsoever.  Right now she has a ‘nasal cannula’ with
room air to help with the breathing.  My friend nurses twice a day while
baby also feeds with a tube, she’s ‘nipple-fed’ either at breast or with a
bottle every other feed.  With three other children at home, my friend is
able to go to the hospital just twice a day.  The doctor’s protocol for when
baby goes home is to ‘nurse just twice a day and then pump and mix the
pumped milk with powdered diary baby formula and bottle feed her all the
other feeds.”  Mom is desperate to find non-dairy and non-soy supplements
for the needed nutrients.  Pretty sure her ideal is to nurse exclusively and
give the extra stuff in vitamin drops.

I sent her The Academy of Breastfeeding Medicines’ Protocol on graduating
from the NICU.  My friend’s having a hard time with the doctors in general;
they’ve pressured her to give the Hepatitis B vaccine.  The dietician was
nice but didn’t want to assign baby a no-diary no-soy formula without
indication that she needs one since they are expensive. 

Thanks for your help!
Laura McCormick, LLL, Burlington, VT
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