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HMF w/ a 30 weeker??

post #1 of 9
Thread Starter 
DD was born at 30.3 and weighed 3lbs 9oz. She was loosing weight until she started to get BM. She was gaining great till they reduced her intake back to 20cc (from 28cc) when she started to stay the same and then loose some. She has had 2 great nursing sessions so I'm guessing she's using more calories and thus the weight loss.

When I argued that her weight loss occurred because they reduced her feeding (she had two watery stools is the only reason), the doctor said she could see my point but said it was the standard of care and that she needed it for the calcium for her bones. From what I've gathered, that's not so or at least controversial for later born preemies but am unclear as to preemies born at 30 weeks.

Is HMF *really* necessary?

BTW...DD is now at 33 weeks gestationally. I insisted they they stop the HMF (boy, did the doctor get snippy...oh well) but am willing to to reverse that decision if it's best for DD.

Any input is GREATLY appreciated!!
post #2 of 9
I really hope someone is able to post some advice for you! We never encountered this situation, so I am of no help.

From what I've read, HMF protocols vary from hospital to hospital. At the very least, they can try going without for a couple of days, and if her weight increases, then all is well.

Many hospitals give it because it's protocol, not because it's truly warranted.

Anyone else have any thoughts???

There was a recent thread about HMF- you might try going back a few pages to see if you can find it.

Good luck mama. It's never good to have to argue with the staff during what is already a difficult time.
post #3 of 9
http://www.uihealthcare.com/depts/me...humanmilk.html

This link has some good info. Good Luck getting them to listen to your wishes but I suspect they will fight you on it and you will have to get ugly with them if you really don't want her to have it and they might just continue to give it to her anyway no matter what you say at least that is my experience.
post #4 of 9
post #5 of 9
We were in a similar spot one week ago!

At first our son (born 3 pounds 13 ounces at 31 weeks) was not tolerating the HMF well, but after a few days he seemed to get used to it. As we approached 33 weeks, we agreed to continue using the HMF when he was tube fed but to also continue working on breastfeeding. Our plan is more or less to stop the HMF when he's fully breastfeeding.

Over the last week - he's 34 weeks today - he's really figured out breastfeeding and he's now getting about two thirds of his milk by breast instead of gavage. When we go home in about a week, we'll probably be exclusively breastfeeding. If he doens't gain enough weight like that, we'll consider fortifying.

We talked a lot to our lactation consultants and neonatologists about it. They had several thoughts. First, the HMF has not only extra calories but also extra minerals that the baby misses out on. The baby can get extra calories if you give him mostly hindmilk, but maybe not enough calcium.

The lactation consultants advice was to use the HMF, but to also use hindmilk. The hindmilk as more digestive enzymes that help the baby digest the proteins in the HMF.

We did some research online and it looks like many nicu's stop the HMF around 1800-2000 grams. Zephan's just over 2000 today, and as I said, we're stopping the HMF little by little as he takes less by gavage and more by breast.

We had concerns, but in the end I guess we decided that as long as he was tolerating it, we would use the HMF until he was breastfeeding but that we would not suppliment after that point unless there was a clear reason that he needed it.
post #6 of 9
Why did they decrease her volume?

My dd is a 27 weeker & she came home on hmf. She wasn't gaining on straight bm.
post #7 of 9
Thread Starter 
Thank you so, SOO much, everyone! It's so great to hear all the feedback and input.

Quote:
We had concerns, but in the end I guess we decided that as long as he was tolerating it, we would use the HMF until he was breastfeeding but that we would not suppliment after that point unless there was a clear reason that he needed it.
I think this is where we are too. At this point (DD isn't gaining consistently), I'm not seeing a good reason not to use the HMF. Your post brought so many things together. It's especially good to hear an LC's opinion about HMF.

Thanks, all!
post #8 of 9
Is HMF *really* necessary?

BTW...DD is now at 33 weeks gestationally. I insisted they they stop the HMF (boy, did the doctor get snippy...oh well) but am willing to to reverse that decision if it's best for DD.

Any input is GREATLY appreciated!![/QUOTE]

I did a lot of research on HMF, even talking to some researchers when it was happening with us. While I don't think I can find all that stuff in my basement now, what I will say is that if baby is gaining on your breastmilk then I would continue to refuse the HMF. It can be associated with problems. Also you breastmilk is tailored to your baby. Our bodies make preemie milk that is richer than term baby milk. So I would not worry about your babies nutrition. I was unable to avoid it for three weeks before discharge (my baby was gaining very slowly and sometimes staying static in weight which is the norm for all of my babies -all six) and was fighting other stuff at the time and had to let go on something. However when I got her home I took her off it immediately (they had told me she had to be on it for six months- HA!) and she did just fine. Still grew slowly as all mine do but my ped is used to that so she didn't blink. Good for you, keep standing up for your baby!!
post #9 of 9
HMF is given, not just for calories, but for additional minerals, and protein, that human milk does not deliver in quantities similar to a placenta.

One company makes a milk fortifier from human milk, Prolacta. The milk is processed and water removed to make a concentrated amount of liquid to add to normal expressed milk. It is only dispensed to NICU's though.

We know that infants do have better growth and mineralization on the fortified milk, but we don't know if "catch-up growth" or trying to grow a preemie as though they are still on the inside, is the best thing to do. No long term controlled studies have been done to compare, that kind of study is so expensive it will probably never be done either.
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