Jeanette:
It is common practice in our NICU to add human milk fortifier (currently we
use Mead Johnsons powdered product) once a VLBW infant has reached full
feeds (approx. 150cc/kg/d. We do not do creamaticrits on the mother's milk
 - however we routinely instruct the mother on the collection of hind milk
when her milk volume greatly exceeds the infant's needs. For instance, one
mother we are following now expresses approximately 10-12 ounces every 3
hours. The infant's daily milk intake is only about 40cc at this time.

Also, is the infant receiving milk via continuous infusion, or bolus
feedings. Sometimes changing to bolus from continuous improves fat delivery.
If this is not possible, look at how you are delivering the milk. Is the
syringe full of milk attached to the infusion pump connected directly to the
feeding tube, or is there extension tubing being used which may decrease the
amount of fat delivery due to adherence of fat to the sides of the tubing.
Make sure the nurses are pushing the last 1/2 cc. or so of milk left in the
syringe before changing syringes -  this is usually all fat!

Generally, if hindmilk feeding, the addition of HMF and making any
adjustments in delivery doesn't improve weight gain, we will recommend that
the infant be supplemented with corn oil 0.5cc every 3 hours given as a
bolus rather than mixing with the milk. Finally, I feel the main point to
make to the mother by all the staff is that her milk is adequate, it does
not lack anything - it is simply that the infant's needs are SO GREAT that
it is necessary to add supplementation.

Hope this helps. Please feel free to e-mail me privately if you wish.