Hi all:

There was some recommendation from AAP regarding fortifying the formula or breast milk in VLBW for 6-9 month or until the infant get into acceptable growth chart lines.

As far as I k ow, many VLBW don't have a catch up growth may be until somewhere between 1-2 years. Of course even worse with the sick infants , SGA or IUGR.

My questions are:

What is your routine practice in discharging VLBW on fortified formula or BM. How do you recommend continuing that? Do their pediatricians follow the recommendation? How would you decide the fortification strength and length? Studies ?

How do you guarantee that the nursing mother will continue pumping and fortifying the milk? Meaning its a bit hard and nursing right from the breast is much easier.. Do you recommend Breast feeding late say 4/-5 times and some 22 cal/oz 2-3 times daily ?

Thank you !

Feras

Our routine practise is to promote breast-feeding as much as possible. Almost all preterms have mother's own milk during the NICU stay and it is routinely fortified as long as the baby is tube feed (up to total protein 4 g/kg/d, and calories/fat until normal growth is reached).

When the baby starts to breast feed, the tube feeding is being reduced until the baby is fully breast-fed AND growth is still ok. However, we commonly see that, after the tube is taken away, supplementary bottle feeding is needed for a good growth.

About 40% of all ex-preterm infants (-34 weeks) are fully breastfed at the time of discharge, another 40% are partially breast-fed and 20% are bottle-fed.

My experience is that fortified milk is less well tolerated (from bottle, I guess it tastes differently).

Our dietician sometimes advice to give some suppl feed's on bottle, occasionally also fortified.

So, in short - we allow exclusive breast-feeding, but monitor the growth curves.