Human Milk Fortifier

[AllieFaye]

Can anyone explain human milk fortifier to me? To my point of view, it looks like a product that reinforces the notion that breast milk isn't good enough for preemies. However, I'm willing to keep an open mind. Is this product better than being told formula-only by hospitals? I'm also half-way to anger after reading the ingredients list. This is for sick babies?

[ein328]

It is not a bad thing!
Babies who are very, very premature cannot get enough calories from breastmilk alone. I'm not talking about babies who are a couple of weeks early- I'm referring to "very low birthweight infants." These are the same type of preemies who receive feeding tubes- too premature to breastfeed.
Often fortifier is given to the babies until they become able to breastfeed on their own. According to my breastfeeding class:
"In a study of feeding strategies for infants born at 26 to 30 weeks gestation, preterm infants fed fortified human milk had slower weight and length gain than infants fed preterm formula. However the human milk fed infants had fewer illnesses and were discharged on average two weeks earlier than the infants fed preterm formula."
The weightgain is slow even when breastmilk is fortified...let alone when it is not. The bottom line is that given fortified breast milk is better than giving "fortified" formula.

[mamabadger]

Dr. Jack Newman does not completely agree with milk fortifiers for premies. Here is an article of his on the subject.

If the mother is expressing enough milk, babies over about 1500 grams (usually about 32 weeks gestation babies weigh this much, though there are exceptions) can grow just fine with breastmilk only, perhaps with the addition of vitamin D or phosphorus, maybe.

The real problem behind this “need” for fortifiers is that it has become a gospel, carved in stone, for many NICU policies that babies must grow at the same rate outside the mother as they would have had they not been born so early. But there is no good evidence to prove that, whereas there is evidence that babies who grow faster than the premature baby on breastmilk has problems later in life...

[ein328]

I was, in particular, referring to babies weighing less than 1500 grams. Obviously, babies born over that weight are a different story.

[pumpkinhead]

Really small and micropreemie babies are not meant to be digesting their own food yet. Doing so actually expends a significant amount of energy for them and if they are not taking in something that is really calorie dense, they may not gain as they should.

Caring for a preemie's gut can be a difficult thing. While it is true that the composition of the milk of the mother of a preemie is different from that of a mother whose baby is full term, nature can only do so much. In many cases, micro-premies are defying nature by surviving and to do so, they need the help of technology which is where human milk fortifier comes in. I think that it has the potential to be misused just like formula, but like formula it does have its place and purpose.

[annekh23]

I like the Jack Newman article, though I disagree a bit with is 7th point, I don't think test weighing every feed is a good idea, particularly with the time limits and not actually know what a baby really should be taking, but having had a baby who looked like she was latching properly, felt like she was latching properly (she wasn't my first), doing breast compressions, listening to her suck swallow pattern etc. we thought the scales would confirm a small but adequate feed, but unless a teaspoon of milk is an adequate feed for a 7lb baby at 10 days old, then those "confirmations" of success would likely had led to readmission to hospital a couple of days later for dehydration, rather than getting on top of the problem ASAP, test weighing has a place, just as milk fortifier does, it's all about correct usage.

[Kailey's mom]

Not just for preemi babes. HMF is also helpful for babies and toddlers, kiddo's who are FTT , kids who refuse to eat enough ,kids with GI problems, kids with metabolic issues, etc.

[theboysmama]

When my bff's dd was a preemie and in the nicu they gave her human milk fortifier w/out even telling my friend. She found out only bcs her dd was allergic to the dairy in the human milk fortifier (she has several children with dairy adn other food sensitivities/allergies so would not have given her dd dairy willingly). She was told it was crucial for her dd to have the human milk fortifier for her to gain weight. After meeting w/ her dd's ped it was agreed that her pumping and separating the foremilk from the hind milk and only feeding her dd the hind milk since it is fattier. She did that and her dd gained great with no need for the human milk fortifier. Her breastmilk had everything her dd needed she just had to make sure she got the fattiest part.
That is my only experience with human milk fortifier.

[boobs4milk]

we argued incessantly with the nicu over fortifying...and lost. we were threatened with the "she won't come home" and the "negletful parenting" spiels. she was 6lb 7.9 oz and 35 wks at birth and was gaining an average of 2 oz PER DAY on my pumped breastmilk.

millie has risk factors for osteopenia and we were told that breastmilk was not enough calories or minerals/vitamins for her. we were told no on giving her any vit. supplements other than those available at the hospital, so no homeopathics. we were also told that what we were giving her was "human" milk fortifier and the staff nearly flat out stated it was made from breastmilk.

wrong. preemie parents need to know that hmf IS FORMULA AND CONTAINS INGREDIENTS SUCH AS HIGH FRUCTOSE CORN SYRUP AND SOY. basically, the extra calories come from bad sugars!!! labeling it "human" milk fortifier is, obviously, deceptive.

we agreed to supplementation to get our baby home. she was 5lb 14 oz at her lowest weight (about 4 days old) and left the hospital weighing 7lb 1.5 oz (at 17 days old) and was only fortified for 3 days of that time.

we asked to have my bmilk tested and we were refused. it all comes down to money and marketing. the hmf is expensive, but we were given free neosure to take home. i wonder who gets paid for that??? the neonatal dr that threatened us sounded like a pharm rep when talking up the benefits of fortifying.

btw, we stopped fortifying her at home and she's now 5.5 mos and 16lbs+. so :P to fortifiers lol

[ein328]

My point was not that HMF is good for everyone. And I'm sorry that it is pushed on babies that don't truly need it.

In my post, I specifically was referring to micro-preemies (less than 1500g- that's 3.3 lbs), not babies over 1500g.

The amount of protein, calories, etc. normally provided by the placenta exceeds what is provided by breastmilk- if babies that pre-term were still in uteru, they would be referring those substances at much higher levels than are present in breastmilk. Look, I'm the biggest supporter of breastmilk in the world, and I'm not trying to make women feel as though their breastmilk is "not good enough." What I'm saying is that micro-preemies need higher levels of nutrition. There is a time and a place for HMF.

...and there is a breastmilk-based HMF...but talking about Prolacta is opening a whole other can of worms...

[SallyN]

Originally Posted by pumpkinhead

Really small and micropreemie babies are not meant to be digesting their own food yet. Doing so actually expends a significant amount of energy for them and if they are not taking in something that is really calorie dense, they may not gain as they should.

Caring for a preemie's gut can be a difficult thing. While it is true that the composition of the milk of the mother of a preemie is different from that of a mother whose baby is full term, nature can only do so much. In many cases, micro-premies are defying nature by surviving and to do so, they need the help of technology which is where human milk fortifier comes in. I think that it has the potential to be misused just like formula, but like formula it does have its place and purpose.

This (bolded). It's not the product that's the problem, but the misuse.

[AllieFaye]

Originally Posted by SallyN

This (bolded). It's not the product that's the problem, but the misuse.

This is why I posted this in Lactivism, instead of Special Needs Parenting or NICU. I'm ready to be swayed by arguments that there is a specific, medical need for this product, for which I am unaware. However, I've heard from so many moms that "my breastmilk wasn't good enough, because he's a preemie," that I wondered about this product. Are moms told outright, "You need to fortify your breast milk, or we'll put him on formula." Or, do some doctors not know about research that shows that breast milk benefits preemies, and are still going on outdated information? I can see how micropreemies are radically different from preemies. I'm wondering about helping those moms who are subjected to propaganda. I'm concerned about informing moms of preemies who are given information that's more appropriate to micropreemies.

[pumpkinhead]

Originally Posted by AllieFaye

This is why I posted this in Lactivism, instead of Special Needs Parenting or NICU. I'm ready to be swayed by arguments that there is a specific, medical need for this product, for which I am unaware. However, I've heard from so many moms that "my breastmilk wasn't good enough, because he's a preemie," that I wondered about this product. Are moms told outright, "You need to fortify your breast milk, or we'll put him on formula." Or, do some doctors not know about research that shows that breast milk benefits preemies, and are still going on outdated information? I can see how micropreemies are radically different from preemies. I'm wondering about helping those moms who are subjected to propaganda. I'm concerned about informing moms of preemies who are given information that's more appropriate to micropreemies.

Actually, most NICU doctors urge mothers to provide breastmilk for their preemies, especially micro-preemies. They have learned through experience that these wee ones do so much better and are less prone to necrotising enterocolitis when they recieve breastmilk and colostrum as opposed to formula.

Bottom line, a baby born at 23, 24, 25, etc. weeks is not equipped for the outside world. Like I said in my pp, they need more calories than breastmilk alone can provide. They still need breastmilk once they are able to have non-TPN feeds, but breastmilk alone is simply not enough and being on TPN for prolonged periods of time is very hard on the kidneys.

So, in many instances (although probably not every instance. Definitely room for misuse here) it's not a matter of "Your breastmilk isn't good enough, fortify or we'll give him formula". It's more like "Well, breastmilk alone isn't giving him enough calories. We either fortify or increase his feeds which increases his risk of NEC or continue with the TPN and the breastmilk but then risk damaging his kidneys".

[boobs4milk]

i've been doing research and i've found that there is evidence that breastmilk from a mother who delivers prematurely is higher in protein and calories. the problem most mothers have is with supply, not with what's there being inadequate. delivery preterm is a shock and a stress and pumping is usually not optimal. it's very difficult to pump 12 times/day when you have a sick child!!!

i'm fortunate that my body responds well to the pump and i am obsessive compulsive and pumping for my baby was my way to stay involved and sane. i also know the benefits of breastmilk and was commited to establishing a bf relationship even if i had to ep for years.

in some instances, hmf might be warranted. what aggravates me is that hmf is usually given because it's standard practice and no testing or real evaluation is taking place. seeing babies reach a number on a chart based mostly off of babies who were fed formula is not the way to grow a baby, whether that baby was a 25 wkr or a full-term healthy infant.

to me, saying "you breastmilk doesn't have enough calories" is the same as saying "your breastmilk isn't good enough." like i stated previously, i believe nicu babies are forced to accomplish the charts and not just be babies and grow on their mother's milk like nature intended. yes, preemies should be treated speciaaly, but how about trusting a mother's body to do what it should.

my son was born at just over 1500 g and was given the fortifiers to grow. we were threatened into giving him the fortifiers the whole time he got breastmilk (~6 mos) and he was switched to formula mostly because i gave up pumping because i didn't trust my body to feed him. he was 18lbs @ 6 mos old, a weight gain of about 15lbs in 6 mos. i think he was overfed...and i think the fortifiers were unneccesary.

my dd's condition was supposed to suppress her body's ability to use cal and minerals/vitamins and we were told she wouldn't gain without the fortifiers. hooey. she's 16l 1/2 lbs at 5.5 mos and we ditched the 27 cal breastmilk fortification when we got home. she got about 1 weeks worth of fortifier, total.

[annekh23]

[QUOTE=ein328;15141021]The amount of protein, calories, etc. normally provided by the placenta exceeds what is provided by breastmilk- if babies that pre-term were still in uteru, they would be referring those substances at much higher levels than are present in breastmilk. Look, I'm the biggest supporter of breastmilk in the world, and I'm not trying to make women feel as though their breastmilk is "not good enough." What I'm saying is that micro-preemies need higher levels of nutrition. There is a time and a place for HMF.
[QUOTE]

I don't think you can compare what the placenta provides with what oral feeds provide, being attached to a placenta is more like being nourished entirely by IV than being fed orally, so I think it's a false premise to say extra is needed for that reason.

That doesn't mean fortification doesn't lead to better outcomes in certain circumstances, but I think we have to base that decision by looking at outcomes not by what would be happening in the womb, because the baby isn't in the womb, most obvious being the fact the lungs are being used to oxygenate the blood.

It would be interesting to look into the use of HMF and it's long term impact on breastfeeding, like does it reduce the rates at various ages.

[tanyam926]

I attended a professional BF conference last wk and one of the topics was BF preemies and the use of HMFs. I believe that the overall message was that the studies show that the use of HMFs in micro preemies (not near term infants) did show an increase in weight gain, and other protective health factors such as the reduction of necrotizing enterocolitis.

Interestingly, the studies also showed that the preemies who received BM and HMF made from BM (there is only 1 company that makes fortifier from human breastmilk and it's new and not widely available, the rest are made from cows milk) did WAY better than the preemies receiving BM + cow's milk based HMF or the preemies receiving formula + cow's milk based HMF.

The presentation was VERY technical (which I love but I can only absorb so much in the present) and the speaker went over the specific nutrients that micro preemies need more of (protein, zinc, calcium, phosphorus, sodium). The studies that he referenced showed the amount of these nutrients in BM were lower than what was needed for these extremely low birthweight babies.

Now, I believe that BM provides everything that a baby needs. However, I also know that if it weren't for modern technology these micro preemies would not survive at all. They are alive bc of technology and more technology is needed to make sure they do well.

I have never had a preemie, or a baby in the NICU at all and I can't even imagine what those of you who have might have gone through. My heart goes out to all parents and babies in that situation. It's unfortunate that there is still a wide range of practice when it comes to advocating for BM in the NICU. The fact is that the medical community often does not base standard practice on scientific evidence. For example, there have been multiple studies showing that skin to skin w/mom right after birth is better at regulating temp, O2 sat, etc. than the incubator but it's not widely understood or practiced.

HMF, just like everything else, has it's place. Unfortunately, it can be abused just like formula.