Wednesday, 7 December 2011

Breastmilk Fortifier - A NICU Mum's Perspective

Like many expectant mothers, I had intended to breastfeed my baby. I thought I'd deliver naturally, baby be put on my chest for skin to skin, it would find my nipple, and we'd work at establishing breastfeeding.

Having a premature baby introduces you into a whole new world of infant feeding. Joseph was fed through his umbilicus to start with, then after a few days a long line was inserted to feed him directly into his stomach. Joseph was fed a special non formula feed, known as Total Parental Nutrition.

All the while, I pumped my breast milk and stored it, I knew at some point he would be weaned off TPN and onto milk. Milk was used for mouth cares, and for comfort.

At 24 days the long line was removed and Joseph moved on to expressed breast milk via nasogastric tube. After a couple of weeks I was approached by a nurse, stating that due to Joseph's poor growth, his milk would be fortified. I burst into tears. It hadn't been explained adequately, I felt they were adding "poison" to my milk. I felt it was a criticism of me personally. Our unit didn't have many very low birthweight babies, so didn't have fact sheets, or the training to explain to me the rationale, and indeed what this stuff actually is.

The nurse kept saying "its just extra calories", but I wanted to know where those extra calories came from, and no one could tell me.

So just what is breast milk fortifier and why is it used? Breast milk fortifiers are also known as HMF or human milk fortifier. But you must be aware, they are not, for the main part, made from human milk. They are usually made from cow's milk. They contain additional proteins, electrolytes and calories, and are added to human milk to increase its strength. A company in the US does make a human derived version but it is astronomically expensive.

Growth isn't just weight + length. Often we forget that when we talk about preemie growth we're talking about internal organs, the brain, they body systems. If there are not sufficient calories then this internal growth can suffer, and the baby can have very severe problems.

It has been proven again and again that breastmilk is best for premature babies, however it has also been proven that in some circumstances, it is not sufficient on its own and a little help is required, through the use of fortification. In our PCT and I think throughout the UK, it is common practice to stop fortification before discharge, although in some circumstances I am sure it continues.

I do think that it should be a choice, and it should be explained, particularly if you have a family history of lactose or dairy intolerance, all avenues should be explored. I do also think that it is not necessary in all cases, however on our NICU I know it was carefully assessed and during our stay Joseph was the only baby who had fortified milk.


Bliss information on fortifiers



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