Baby in NICU & Human Milk Fortifier - Mothering Forums
NICU & Preemie Parenting > Baby in NICU & Human Milk Fortifier
KatetheWonderful's Avatar KatetheWonderful 05:01 AM 10-04-2005
I swear nothing is easy with a preemie baby. Everything goes against your better judgement and I feel all I do is nod my head because I just don't know. I have a now 34 week old baby in the NICU. He is fed breastmilk with Human Milk Fortifier added. I am having my doubts about the fortifier. He is spitting up alot, seems to be straining to poop, but no poop comes out and he just doesn't smell like a breastfed baby. He smells like a stinky formula fed baby and I find this very disturbing. Anyone else have a preemie and decline fortifier? My baby, Seamus is good sized, 5 lbs 4 oz. Birth weight was 4 pounds 14 oz. I am reading Jack Newman's Ultimate Breastfeeding Book of Answers and LLLI's Breastfeeding Answer Book. I am trying to resist the urge to call the hospital right this minute and say don't pollute his milk anymore!! I could do that right?? Oh, I just want him to come home away from the moniters and feeding tubes. It is so hard to find information.

KatetheWonderful's Avatar KatetheWonderful 05:27 AM 10-04-2005
Ok, I did it. I called the hospital and I said that I didn't want Seamus to have anymore milk supplements until I could talk to the doctor tomorrow. Hopefully now I can go to sleep.
Lula's Mom's Avatar Lula's Mom 11:31 AM 10-04-2005
nak, so I may be able to write more later.

From what I found, I am inclined to agree with you. I'm sure it's fortified with iron, which is probably constipating him. He's at a good weight now; I would think he'll do great on breastmilk alone. I found a reference that said babies under 2000 grams (4.4 pounds) should be on HMF; your son is above that. He was above that when he was born...

Anyway, it's likely that the doctor will fight you on it, because that's what they do. I assume you are pumping for him... are you producing enough to feed him without supplements? Can you pump longer to try and get more hindmilk, so the fat content is higher? Make sure your diet is great, and take a good prenatal, and I'd also take some fish oil capsules (I do anyway, but the added fatty acids could be even more "essential" for your baby).

Lula's Mom's Avatar Lula's Mom 11:50 AM 10-04-2005
kellymom says preemies have less iron stored bc they usually get it from mama in 3rd trimester. So there is more risk of anemia- BUT, supplementing with foods other than breastmilk, including formula, can interfere with the absorption of the iron in breastmilk, which is the best kind for babies. And added iron can increase infections by feeding bad bacteria in the gut, and it interferes with zinc absorption. Sigh. I'm sure your baby has had his hematocrit done- that link has a chart for normal levels. See if he's at risk.
Take tons of Vitamin C yourself- your baby will get 1/8 of what you take in your breastmilk. I would take at least 5000 milligrams, 8000 if you don't get soft stools from it. This helps with iron absorption, and boosts his immune system (and yours- I'm sure you're pretty stressed yourself).
Lula's Mom's Avatar Lula's Mom 12:18 PM 10-04-2005
Is this what you've read from Dr. Newman?
mizmerricat's Avatar mizmerricat 12:39 PM 10-04-2005
I'm also inclined to agree that he probably doesn't need fortifiers any more. He's at a great weight now and growing well. If his rate of growth is a big concern, there are other options. I've had alot of success with pumping more and feeding with a heavier concentration of hind milk.

I remember the "anything to get her home" days!
alegna's Avatar alegna 12:45 PM 10-04-2005

Good for you!

Do you have the new Sears preemie book?

justmama's Avatar justmama 01:30 PM 10-04-2005
Congrats on baby Seamus. Does he get NG feeds? Is he nippling any feeds yet? I have a 34weeker(18inches and 5lbs 3oz) who is now 9 months. She was NG fed until day of life #8 exclusively and really pushed to bottles and breast(breast was unsuccessful until we went home) to come home by day 11 of life. She got HMF to 22cal and was okay and then when they upped it to 24cal, she started throwing up. Seems the 24cal is too rich for a lot of babies to handle(with their delicate preemie guts) and they throw it up. So they went back down to 22cal fortification. And basically yeah it's for the iron. When you get discharged, he will most likely be on iron supplements daily because they DON'T get that iron transfer late in the pregnancy. They are born before that time. So they really do need the extra supplement. I'd decline and let them do the daily iron checks and if he starts getting anemic, THEN go with the HMF.
I know what you mean about wanting your baby home and free of leads. When Sara finally got out of the isolette and into a bassinet, we cheered. Her first piece of clothing was a onesie at day 8 and we took pictures and cried because our baby was growing up and finally in big girl clothing. It was such a happy time. Seamus will be home soon. Weight-wise, he's ready. Now as long as he nipples all feeds and has no significant A's or B's, right? Those last few days or weeks are the hardest. My babe had A's and B's on her last day in the NICU so she was discharged on an apnea monitor because otherwise she was completely ready for home. They were all self-recovered so they still sent her home. And that thing is a pain in the butt let me tell you! Lugging a baby, a diaper bag, an apnea monitor and dealing with another child. WOW! And then the leads kept coming off and false alarming and they ripped at her little chest and then a real alarm sounded and panicked poor dh out of a sound sleep. . .. . . ..ugh. I'm so glad she's big and strong and healthy now. We got rid of our monitor at 4 months. And she's now a 17lb 8 1/2month old girl who's only slightly delayed developmentally. Good luck getting your babe home!

homemademomma 03:22 PM 10-04-2005
it does sound like the main issue is iron. however if getting enough fat/calories is also an issue, ive heard of some hospitals where they have mom pump the foremilk, then switch to another container for the hindmilk, and then they mix the two together into an optimal ratio so that the end result has more fat/calories than "normal" breastmilk. you would have to pump more to do this, obviously, but it sounds like a good idea to me!
Jenifer76's Avatar Jenifer76 04:27 PM 10-04-2005
When my Molly got down to 4 pounds, they put her on HMF. Suddenly, she was a gassy, non-pooping little thing. If you can decline, I would do it. I really feel the only thing that got her really growing was good ol' mama's milk.

Good luck to you.
edamommy's Avatar edamommy 05:21 PM 10-04-2005
hi! My ds was born at 33 weeks. We were in the hospital for a month as it was a high altitude. Anyway, the nurses tried to insist on giving him human milk fortifier one day. They said it wasn't formula, he needed it in his gavage tube for extra fat. LUCKILY my very awesome peditrician came in just as they were adding it to my ebm and said----- NO, the mother wants NO FORMULA! And then she explained to me that it is indeed nothing more than formula. yuck
Periwinkle's Avatar Periwinkle 05:48 PM 10-04-2005
Congratulation and welcome baby Seamus!

I had feeder-grower 31 weekers and I declined the fortifier because I showed them my milk which easily had a 1/2" of pure fat on the top of every pumped bottle (little bottles no less). Preemie milk is wonderful stuff. As long as they were gaining at least 1 oz./day they were allowed to be EBM only (they gained 2+ oz./day!). BUT... yes they did need iron drops until they were 6 or so months old and started iron fortified cereal.
KatetheWonderful's Avatar KatetheWonderful 02:49 AM 10-05-2005
I have to say I am impressed with my dr and the nurses at the hospital. Today when I went in, I was ready with info for my doctor and she was very casual and said lets see how he does. I talked with the lactation consultant and I am working on pumping my fore milk and then changing bottles to have a higher caloric hind milk rich milk for his feedings. I am pumping over 32 oz a day, so this is no problem. The best part of the day was when the night nurse came on duty and she said I am glad you took him off the fortifier, he is doing much better. Another nurse said that she didn't realize that there was cow protein in the fortifier and totally understood why I had issues. So I started the day thinking I would need to fight and stand my ground and it turns out that no, I didn't. With every issue I bring up I am pleasantly suprised at how I am listened to and they don't find me unreasonable. Thanks ladies for your support and availability for me to rant and rave and discuss my concerns out loud so to speak. This is a valuable resourse and I have benefited often.
justmama's Avatar justmama 10:33 AM 10-05-2005
I'm so glad you feel better about this. I rmeember being all prepared to fight for my right to bf my baby when she went into the NICU and fight to get her paci taken away. They were so supportive of bf'ing and when I asked her nurse about not using the paci, he immediately took it out of the isolette and I never saw it in there again. No fights! It felt so good, especially when you feel so out of control and like you aren't even making any decisions. Like you said, all you do is nod your head because you really really feel like you have no clue what's going on and it's all just taking you for a ride. You aren't in the driver's seat anymore. I highly recommend Dr. Sears' "The Preemie Book." It answers a lot of questions and helps youwith bf'ing issues(because with a preemie, it's highly unlikely that you'll have none) and helps you with what to expect from his stay and when he comes home and long-term development and problems. It is really VERY helpful. I would buy it even if I couldn't find it in my local library. I couldn't have gotten by without my maya wrap(she lived in it until 3 months old, LITERALLY!) and my preemie book! Congrats again. I say this only because I really felt like I'd never been pregnant and given birth because I didnt' have my baby with me. And she was only in for 11 days but it felt like years. You are a mama! You have a little miracle baby. Even those 34 and 35 weekers at 5lbs are miracles. Each and every one of them. And the parents are amazing for what they go through and what they do to make their babies healthy and ready to come home. It's an uphill battle and each day is a rollercoaster with a preemie. Best of luck to you!

Sarah's Avatar Sarah 11:46 PM 10-05-2005
What a happy update! Congratulations on your new baby!
Love Sarah
acrathbun's Avatar acrathbun 12:07 AM 10-09-2005
neither of my preemies could tolerate the HMF. I let the NICU know w/my second preemie that he could not have anything w/ dairy in it, and the HMF has cow's milk protein (as you know )

They were extremely supportive, etc., and encouraged other wonderful things like kangaroo care...

We also did the hind milk pumping thing, and wow! lots of rich fatty breastmilk. Thomas was a slow-gainer those first few weeks in the NICU, but made up for lost time once we got him home.

Good luck w/ Seamus!
orangebird's Avatar orangebird 01:24 AM 10-09-2005
I work in a NICU, use HMF all the time. If I recall correctly, it doesn't have iron in it. I think we use it way too much on the near term kids. It is necessary for the tiny preemies, but I'm always questioning it when use on kids, like yours, born over 5 pounds and so close to term. But I agree, I think it is yucky on their tummys.