great discussion regarding the fortification of breast milk for premies! Thank-you so much Sharon for sharing your EXTENSIVE review of the research and info on lactoengineering, applied specifically to the case of Alicia's poorly gaining, former 29 wkr. I wholeheartedly agree with your suggestion to FIRST "manage" the pumped milk into a pool that is likely higher in fat. And, as she suggests, If the weight gain remains low, try the crematocrit. Although the teeny premies seem to need more than mother's milk alone provides, how wonderful it would be if every NICU/nsy had protocols instituting the above measures BEFORE embarking on the infinitely more risky road of breast milk "fortification", if even for the "older" premies only! Unfortunatley the factual pix is quite different. Since the advent of *premie D/C formulas* and the research data supporting its use, even the older premies are dc'd breast feeding very little and suppmt'd with every feed, at a rate much higher than in the past. My most recent VNA admission was for a 2wk old former 34 wk premie, dc'd nursing 2xday only, and suppmt'd at each feed with formula enhanced MM 24cal. Upon my eval the baby had little experience at the breast and all attempts up til that point were largely nonnutritive. Further assist revealed that the baby was very capable and my D/C instr. were to "try" to br fd only during the day, pump after each fd and suppmt with pumped milk after nursing at night. Phone call to Mom revealed that Pedi disputed this on visit the next day, insisting that Mom continue suppmts each fd. Visit 3 days later revealed that Mom had done little suppmtng/ less than 5oz day because baby refused and or spit up when forced. Lengthy disc around huge wt gain, s/s of satiety etc. reassured Mom to continue to follow her instinct and not suppmt if feeding appeared adequate. Visit to pedi 4 days later revealed cont'd huge wt gain and pedi's recommendation to D/C suppmt (he was surprised to hear that Mom already had ;)). My visit 1 wk later revealed 17oz wt gain in 7 days , exclusively brfed. Of course in this instance all was well in the end BUT if this Mom did not have the benefit of a home visit by an RN/LC, as most do not, we know from the research that the most likely scenario is abandonment of the br fdng. And, as Valerie suggests, the message that Mom's milk alone isn't good enough is a very powerful one. Lynn Shea Rn,Bsn,Ibclc Franklin,Massachusetts *********************************************** To temporarily stop your subscription: set lactnet nomail To start it again: set lactnet mail (or digest) To unsubscribe: unsubscribe lactnet All commands go to [log in to unmask] 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