Does my son really need HMF?

[NeivaKai]

My son was born at 33 weeks 5 days, 6 days ago, at 4lbs 12oz and has been breastfeeding, gaining weight (he is only 3 oz under his birth weight at this point) and seems to be handling things. He is gavaged every feeding, but nursing maybe a fourth of each feeding from me first (we are weighing him, then putting him to breast, then nursing and weighing again). He is spitting up a little bit, but they have really ramped up the amount of milk he gets every feeding, finally plateauing now at 40 ml/a session.

They now want to put him on Human Milk Fortifier, and I am extremely hesitant to do so. My ds1 reacted to milk very badly (rashes, colic to the point of 24/7 colic) in my breast milk until I figured it out.

The reasoning they give me is that I don't have enough protein, calicum, magnesium and phosphorus in my breastmilk, or calories. That I will affect his brain and bone growth if I don't feed him the fortifier, because he would be getting so much more in my womb and be working less than he is now. But I want them to test my milk! And of course they can't, which is pretty silly because they can test Burger King nutritional content, why can't they test my milk huh?

Does anyone think NOT giving their babies HMF while in the hospital has affected their baby?

Funny thing is, they don't think I need to continue to give my son HMF once we leave, because then he will be at term and not need it.

The neonatologist did say, that it is more necessary for babies much younger than mine, and if we didn't want to do it they wouldn't push it, but the nutritionist was being kind of a brat about it. I am SO glad I am spending so much time in the hospital!

[princess_tre]

I am not going to give you an opinion, but I will give you my experience.
My son was born at 30 weeks and spent 5 weeks in the hospital. He was on breastmilk fortified the whole time in the hospital. When he was discharged, they told me to fortify with Neosure by similac (lay people cannot get human fortifier). I was told that even if I nursed, my son should still get a fortified bottle. My pediatrician recommends preterm babies to be on Neosure formula or fortified milk with neosure for at least a year. Preterm babies need more phosperous, calcium and other vitamins.

After I could no longer pump (my body's decision) months later, we put him on the neosure formula. It did not agree with him. Funny how having fortified milk did not matter. His reflux and spit up was so much worse. My dr. changed him to another formula and said if that if I give him the vitamins he will get everything he needs. So there are alternatives to the fortifier.

[DocsNemesis]

I had a very different experience. With my ds, they added a bit of neosure to each bottle of breastmilk while he was in the hospital. Once we left, my sons pediatrician said I could try cutting it out and just watch his growth. As soon as we got home, I cut out the formula and put him on a on demand feeding schedule, rather than the every 3 hours thing they had him on.

Its really really hard not to keep obsessing over the amount they intake, especially with bottles, but after a few days I stopped worrying about it. He was taking in a LOT more than he did in the NICU and thats all I needed to know. In any case, he gained over 3.5 pounds in the first month after leaving the NICU, so obviously he was doing fine! Oh and I had cut out the vitamins they had been giving him to-they made him puke, which to me seemed to kind of defeat the purpose.

He's 14 months old now and doing fine. His pediatrician said not to supplement unless he started having growth problems. He hasnt. He's also had his iron levels tested and that came back fine as well. He's very healthy and really REALLY likes food

[sbrinton]

I think I shared our experience with HMF on the other thread, but I can repeat it here too!

With our 35 weeker who weighed 5 lb 8 oz, we went straight to on demand breastfeeding and never looked back. He gained weight easily in the first few months and is now a healthy 2 1/2 year old.

With our 31 weeker who weighed 3 lb 13 oz, we began with gavage feeding and then transitioned to breast feeding. We did not introduce bottles until we were breastfeeding 5-6 feedings each day and he was pulling out the gavage tube constantly. We argued with the doctors about HMF almost constantly. We didn't want to use it. When our son had it in the milk, he spit up a lot more. He also had much more left in his tummy after 3 hours (they would check before the next gavage feeding). He seemed to digest the breastmilk much better. Once he was breastfeeding and bottle feeding, he would take 60+ cc of breastmilk by breast, but only 35 or so cc of fortified breastmilk by bottle.

We were worried about the possibility of a milk allergy, and sure enough, he's allergic to milk now that he's 10 months old!

In the end, we let the hospital fortify 2-3 out of 8 feedings, but we probably should have refused this. When we went home, we went straight to on demand feeding and he did really, really well.

That said, he was growing well in the hospital, I had a great milk supply, and he was not a "micro" preemie who was at high risk for issues like rickets. So if my supply was low or he had been struggling to grow, HMF or formula may have been the right thing.

The main issue we still have is iron. He's still anemic, mostly becuase it's hard to get him to swallow his iron suppliments.

[Crunchy Frog]

I'm thinking that the answer to your question is probably "no".

My twins were born at about the same gestation as your boy; 33 wks 3 days, and quite a bit smaller; 3.9 and 4.1, and they never had any HMF or special formula at all.

They did have TPN their first 1 1/2 - 2 weeks, and I don't know if that would be comparable. Mostly I think it was just to keep them going until they could get all their nutrition orally. They never got a feeding tube, and only had my bm by either bottle or breast, until my @#$% boobs couldn't keep up with their demand, and then the were supplemented by ordinary Enfamil Lipil.

They haven't been on any special formula or diet since, and they've been thriving. That, even though they were still only 4.10 and just under 4 lbs. They haven't had any problems in growth either, as they've already caught up to their actual ages sizewise (and that was by 6 months).

So, to sum up, I would guess that your hospital wants to do it just because it's protocol for that particular hospital, and that it really isn't needed.

I did find this article on preemie feeding that you may find interesting. http://thebabybond.com/FeedingPreemi...tSurvival.html

Best of luck in whatever you decide. Please keep us updated.

[ouesi]

Originally Posted by NeivaKai

The reasoning they give me is that I don't have enough protein, calicum, magnesium and phosphorus in my breastmilk, or calories.

THIS IS NOT TRUE!! And darn it, I can't find the literature now, but I know of at least two studies that show that moms who deliver prematurely produce different milk than moms who deliver at term. In fact I think Dr. Sears has written articles about this.
If this is the only reason they're giving you, I would not do it. If you son is having trouble gaining weight or growing, maybe, but it doesn't sound like this is the case.
My twins were born at 32 weeks - DS never had anything but BM in NICU, DD who was much smaller did. They supplemented without my knowledge, and DD ende up having an NEC scare. (Blood in her diaper - turned out to be nothing, but by then they had already pumped her full of antibiotics.) Now, the supplementing and NEC scare could just be coincidental, but if I had to do it again, I wouldn't risk supplementing unless BM was clearly not enough.

[Crunchy Frog]

Originally Posted by ouesi

My twins were born at 32 weeks - DS never had anything but BM in NICU, DD who was much smaller did. They supplemented without my knowledge, and DD ende up having an NEC scare. (Blood in her diaper - turned out to be nothing, but by then they had already pumped her full of antibiotics.) Now, the supplementing and NEC scare could just be coincidental, but if I had to do it again, I wouldn't risk supplementing unless BM was clearly not enough.

Don't know if this is relevant to the discussion, but the NICU where my twins were at has an extremely conservative feeding policy and say that that is the reason they have about the lowest incidence of NEC in the country.

My twins did not gain much weight while they were in the hospital, and I think they were actually a little underfed. As soon as we got them home they wanted bigger feedings than what they'd been getting and started growing like weeds.

Seems to me like the HMF is taking an unnecessary risk unless the baby is really tiny or early.

Glad your DD ended up okay.

[DocsNemesis]

I too have read several studies saying that breastmilk produced for preemies isnt the same as full term babies.

It makes sense really. I mean, our breastmilk content changes as the baby ages. We know this. So why wouldn't our bodies know that this baby was born early and therefore needs a different milk?

Also, I can say from experience that my milk had a very different consistency for my preemie than my full term babes. It was very heavy and thick-like whole milk straight from the cow . For my other babies it was more like 2% or something and later more like 1%.

We also know that breastmilk is digested much more easily and efficiently than formula. That's evident just by their poop and by them needing to eat more often. Having something in their bellys that doesnt digest as fast, leading to them feeling full longer and eating less just can't be good for a preemie.

[NeivaKai]

We have said no to the doctors, and they are backing off because my DP is a wiz at learning terminology and he understands statistics amazingly well. We did some research and found that the growth chart the majority of doctors use is a combination of two different growth charts, one for term or near term babies, 38 weeks+ and one that was for 36 weeks and under, the former from a Swedish study of 30,000 babies and the latter from Australia of 3,000 babies. They were combined using a method called the Benefereti Equation (I am not sure on the spelling). It is an equation that basically makes a line between two marks on a graph and takes the mean of the two to establish a new line. It's calculus, not actual babies.

So in essence, it's BS.

I am so grateful for such a smart partner. He is going to bat for our baby and it's awesome. We have found a lot more stuff too, about studies which you talked about DocNemesis, where the babies don't digest the formula fully anyway.

Also, we found that NO manufacture or research recommends using HMF for babies over 2000 grams, which my baby has never been. He came out at 2150.

And he now is OVER his birth weight, and is 2165 WOOOHOOOO!

[tana'smama]

My ds was born at 35 weeks 4 days and had moderate to severe lung disease. He weighed 5 lbs and 4 oz and was in the NICU for 4 weeks. He was just a little over 6 lbs when he came home and I have EBF him (NO sup's at all) and he is 3 months old and weighs almost 17 lbs. Have faith in the breastmilk and if it doesn't seem to be working then think about sup'ing. I really don't think you will have to.

[Lil'Momma]

My last two were early with ds 2 being 32 wks and dd being 34wks and both got the HMF after being threatened by the doctors to call CPS. While they were on it, they were gaining like 4-7 ounces A DAY. It was crazy... once we came home, their peds said, take them off, they don't need it. They told me preemie breast milk is much different than Full Term milk, with higher cal, protein, ect, they said my body knows what my baby needs and will act accordingly. I threw away my Neosure and they were fine. (My ds 2 never did latch, so he eventually ended up on formula, but not the Neosure, that stuff just didn't settle on his stomach, we went with basic, normal Similac and he never had any issues with Iron, weight, any of that)

[DocsNemesis]

Wow that is crazy. Like I said, mine was a very slow gainer in the hospital where they were supplementing him. He was 4lbs 13oz at birth (at 32w6d), dropped to 4lbs 7oz that first week and was only 5lbs 7oz when we brought him home a month after being born. He really didn't have much net gain.

I honestly don't know if it was the supplementing or the hospital environment itself causing his slow weight gain, because I cut out both the day we came home. I do feel though that as a preemie gets closer to their due date especially, and esp if they are awake more often, they should be offered food more often. My son seemed to like taking in about half of what the hospital had been giving him, every hour or less instead of every 3. Again, it might have helped having him off the supplements there though, since he was probably digesting all that breastmilk in an hour or so and ready for more. I'm not sure how that would've panned out had he still been on them.

The NICU can be a total pain, but it sounds like he's doing really well and its good they arn't making threats-thats terrible, threatening to call CPS over it. Although frankly I'd let them now, lol. I've been involved with CPS enough that they know me pretty well so I'm not really scared of them anymore. (My eldest has a lot of issues that result in a lot of calls. Blarg.) Thats just crazy though, they didn't even make threats when I took my son home AMA (hospital policy was keeping him there and after 2 weeks I said enough.)

[~bookcase~]

i heard that b'milk is different only for the first few weeks and then goes to full term milk, but i'm not sure i believe it. lol. considering every single mama makes unique milk for her children

anyway, mine were given hmf w/out permission and we had them stop when we found a study that showed preemies as opposed to micro preemies can do just as well without it (if not better: improved bone density in one study)

glad your dp is able to do the talking
nothing like letting them get on with the protecting us to free our energy up for expressing, resting, nurturing......

[NeivaKai]

Update

So we came home after finding out if we fed EBM by bottle for 24 hrs. He came home and within 5 days was on boob totally. He did what I thought he would, feed every hour for a little bit, and gained 10 oz his first week out. He is now 9lbs, at adjusted age of 2weeks!!! At his due date he was the weight his brother was when he was born. He rolled over at 3 weeks (3w before his birth date). He is tracking, smiling, grasping directionally...entirely normal. We never fed HMF and he is great! We are so glad we made the choice to follow our instincts.

[Bokonon]

Congratulations, this is a WONDERFUL update!!!! Way to go mama!