Intro and Milk fortifier question

MrsLaurenandDan

I haven't lurked or anything yet, just glanced at the last 2 pages, so please forgive me if I ask a question that is asked a lot. 

My son Owen was born 8 days ago at 33w5d.  He;s been doing really well in the NICU.  HE was 5lbs4oz at birth, and he is already back up to 5lbs 1oz.  He only had to have the nasul cannula for a day, and he is in a crib and on room air.  They took his IV out yesterday.  

So far Owen has only had BM for all his feedings.  I have been trying to BF, but also pumping and giving him a bottle.  He isn't quite strong enough to take all 45ml by mouth yet, so after he eats what he can from me/the bottle, he gets the rest of the breastmilk through a tube if he hasn't finished.  (he does manage sometimes, just not every feeding.) 

 The Dr today ordered a supplement of Enfamil Human Milk fortifier to add to my milk.  I had never heard of this and it took me by surprise.  I've worked really hard pumping to make sure that Owen hasn't needed any formula.  I really don't want him to have anything other than breastmilk, and I don't feel I'm getting a balanced picture of the pros and cons from the NICU.  Anyone else not fortify?  I'm just trying to get a picture of how necessary this is.  Thanks!

bhilyer

The HMF will give your BM a calorie boost. Both of my boys were on EBM in the NICU but were having HMF added to it for extra calories.  More calories = more weight gain.  

The HMF is derived from cow's milk protein.  It's not "formula" per say, but I understand about the EBM thing.

I delivered at a top US research hospital and they now believe that HMF may contribute to NEC in some babies.  One of my NICU mommy friends had a NEC scare with her girls and when they stopped adding the HMF, her girls had a complete turn around.

I think it's fairly common to fortify with HMF while babies are still in the hospital, but definitely not always necessary. For me, my boys were 2#10oz & 1#7oz, so I didn't think twice about having the HMF added.  My smaller guy was on double HMF and the neo add MCT oil a few weeks later to fortify to 30 calories.  My bigger guy decided one day that he would not take fortified milk, so they stopped adding it.

GL! 

WaitingforGrace

We fortified with HMF in the NICU and then with Neosure added to breastmilk once they were released. Weight gain is something my girls struggled with and the benefits of the added calories and nutrients was well worth it for me. Being preemies LO's aren't able to benefit from the last however many weeks in utero where so many nutrients are packed on at the end and the HMF and Neosure helped my girls get that.

FWIW, I still say they had 100% breast milk for their first 6 months of life even with the HMF and Neosure.

WaitingforGrace

bhilyer:

I delivered at a top US research hospital and they now believe that HMF may contribute to NEC in some babies.  One of my NICU mommy friends had a NEC scare with her girls and when they stopped adding the HMF, her girls had a complete turn around.

 

This is excellent information, but don't be scared by it because at almost 35 weeks your baby is not really at risk for NEC.

MrsLaurenandDan

Thanks ladies.  Hearing from other Preemie moms really helps.  My guess is I'll be here a lot more often.  I'm heading back to the hospital in a few, so I won't be on, but I'll check back later. 

HJOHNSTON411

I don't want to scare you, but we had a scary experience with fortifier.  Our LO is MSPI, which we didn't know then. 

At 2 wks of age they started adding Neosure to fortify.  He immediately began to spit up his feeds (which he had NEVER done).  They told us not to worry, that he was probably just getting used to it, blah blah.  About 24 hours later our poor LO was getting xrays and spinal tap to check for NEC and meningitis.  All tests came back fine, but he spent 3 days back in the NICU's intensive care, stopped feeds, IV back in etc. 

We now know for sure that he is MSPI, so basically he was just having an insanely bad allergic reaction.  There have been many studies in recent years that indicate that allergic reactions can mimic NEC symptoms etc. 

Having said all of that, many babies do FINE on fortifier, and there are benefits.  My experience just happened to be a bad one.  If they start it, and your LO seems to have any trouble tolerating it though, my suggestion would be to stop it immediately.  If we had followed our instincts after those first few feeds, we might have avoided a lot of heartache.

GL!!

lwmooney87

You're actually really lucky that your doctor ordered a Human Milk Fortifier to be added to your BM. I wasn't given that option and they automatically fortified R's milk with Neosure (which is formula). I wanted her to have just BM too.

The reason they ordered a fortifier is to add calories. BM is only 20 calories and preemies (and low birth weight babies), especially at first, need a little calorie boost. In order for them to pack on pounds, they need the extra calories.

The human milk fortifier is MADE from breast milk. Don't get grossed out though- it's not like your baby is getting someone else's breast milk. They are just getting broken down elements of breast milk that was donated to milk banks and such.

So no worries- it's a good thing You want your LO to gain the weight they need to so they can go home!

bhilyer

WaitingforGrace:

bhilyer:

I delivered at a top US research hospital and they now believe that HMF may contribute to NEC in some babies.  One of my NICU mommy friends had a NEC scare with her girls and when they stopped adding the HMF, her girls had a complete turn around.

 

This is excellent information, but don't be scared by it because at almost 35 weeks your baby is not really at risk for NEC.

Good to know.  I only know about 29 weekers and NEC

Also, to OP - one of my college roommates is a nurse practitioner at the NICU where the boys were.  She was there to hold my hand along the way.  I knew that she was well-educated and trusted what she told me.  When she mentioned HMF, I knew it was the right thing to do for my boys.

 

katie4253

I disagree about the NEC not being a concern at 35 weeks.  The neos always made sure we understood NEC was something that could happen until he was 40 weeks.  Maybe it was because our LO was IUGR and had an underdeveloped gut, but it was something they talked about A LOT.

Anyway, Gabe was put on HMF 22cal in the NICU.  They tried quite a few times to do 24 cal, but he couldn't handle it at all. He would brady and desat and vomit.  It was scary.  Some babies are fine with it, but it can be hard.  So, I'd have a conversation with your neos about introducing HMF slowly.  As in, increase density (calories) OR increase volume.  Not both in one day.  When they did two things at once we never knew which thing caused the issues, so it was hard to know what the next steps should be.   

Mrs. Alice

WaitingforGrace:

We fortified with HMF in the NICU and then with Neosure added to breastmilk once they were released. Weight gain is something my girls struggled with and the benefits of the added calories and nutrients was well worth it for me. Being preemies LO's aren't able to benefit from the last however many weeks in utero where so many nutrients are packed on at the end and the HMF and Neosure helped my girls get that.

FWIW, I still say they had 100% breast milk for their first 6 months of life even with the HMF and Neosure.

Same for me too.  At first they were on 26 cal, then 24 and then before discharge they went to 1/2 Neosure 22 cal and 1/2 BM with bottle feeds.  Now that they are at home the Dr. wants them to have at least 2 bottles a day of 1/2 Neosure and 1/2 BM which I also add their vitamins to.  They are doing great so far with gaining weight.

JeepersWife

My DS was born at 34 weeks due to severe IUGR weighing only 3.5 lbs. I immediately started pumping so he could have BM. We were not given an option about starting the HMF, but I am glad we did. It really helped LO gain weight and we've been continuing to fortify since being home. He is nine weeks today andeeighs 7.11 lbs. We fortify to 24 cal. He is only in about the 3rd percentile for weight and height so we will be fortifying for a bit.

JeepersWife

Oh, and we fortify with Enfamil AR due to reflux...

MrsLaurenandDan

lwmooney87:

The human milk fortifier is MADE from breast milk. Don't get grossed out though- it's not like your baby is getting someone else's breast milk. They are just getting broken down elements of breast milk that was donated to milk banks and such.

Actually, it's not.  It's called human milk fortifier because it is fortifying human milk.  There are ones made from donated breast milk, and I would actually be a lot more comfortable with that.  

We spoke to the Dr finally, and we have agreed not to fortify.  Most of my research today has not shown that the risks would be worth it.  He's not having any trouble gaining weight.  He was 5lbs 4oz at birth, which is great for only being 33w5d.  And at 7 days old, he was already only 1 oz away from being back up to his birth weight. 

Honestly, the Dr ordered it, but when we questioned the need, his first response was that if we didn't want it, that it was fine.  So I guess it wasn't too much of a priority for him. 

lwmooney87

My bad, I was under the impression that you were taking about the one made from breast milk.

Sounds like you've got your mind made up and did your research. Good luck.