This is a very “hot” area of discussion and research. Breastmilk (BM) fortifiers (the powder packets) are not meant to be used outside the NICU, and without someone following labs, could be dangerous. When fortification os necessary, we use supplemental “follow-up” formulas, either as the powder added to BM or from 1-3 feedings a day.

It is not the calories that is important – it is the extra protein, calcium and phosphorus – that is important for optimal growth. We know that ex-premies grow FASTER with post-discharge supplementation, but we don’t know that it is BETTER in the long run, as exclusively BM-fed premies do catch up eventually (2-8 yrs re bone mineralization).

The Academy of Breastfeeding Medicine will be publishing an evidence-based guideline on post-discharge nutrition for the NICU grad in the next few months. The primary author is Richard Schanler MD. For other breastfeeding-related protocols go to www.bfmed.org and click on protocols. I also presented on this topic at the LLLI Physician’s conference in San Francisco last July. T

he audiotape or CD may be available from LLLI.

Nancy E. Wight MD, IBCLC, FABM, FAAP Neonatologist, Sharp Mary Birch Hospital for Women and Children’s Hospital Medical Director, Sharp HealthCare Lactation Services San Diego, CA [email protected]