1- Many doctors do not know the current nutritional recommendations.
2- Saying 22 or 24 cal is an easier way to say supplement with  
mutlinutrient fortifier.
When I order breastmilk fortified with NeoSure to 22 calories I am doing it 
 for the extra protein, calcium and phosphorus, not the extra calories, but 
the  calculations are based on calories - simpler for nurses and parents.
 
Nancy
Nancy E. Wight MD, IBCLC, FABM,  FAAP
Neonatologist
Sharp Mary Birch Hospital for Women and  Newborns
Medical Director, Sharp HealthCare Lactation Services
San Diego,  CA 
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