Fortifying breastmilk for premature baby?

[KashaSarrasin]

Help! The doctors want to fortify DS2's milk and I'm not sure what, if any, disadvantages there are to this - anyone know?

DS2 was born at 31 weeks and is now 18 days old, he took a while to regain his birthweight of 1.39kg (3lb) but is now at 1.58kg (3lb8oz). He's being fed EBM via a tube and the last few days has started to latch on and feed directly . His weight gain has averaged 45g/day over the last few days so adequate weight gain isn't an issue AFAIK.

But his alkaline phosphatase levels are elevated - 778 on the 14th up from 378 on the 7th, and this is why the doctors want to fortify. The doc explained to me this was associated with metabolic bone disease / rickets of prematurity (which obviously I don't want DS2 to get!). He's already on a double dose of Abidec vitamins, plus sodium phosphate and folic acid.

What's worrying me about the fortifier (Cow and Gate nutriprem breastmilk fortifier) is the cows' milk derived ingredients. Does anyone know what the implications are for future gut problems if he has this? I exclusively bf DS1 for 6 months and it's really upsetting me (rightly or not) to think of DS2 getting cows' milk protein so early . It's a question of weighing up the risks vs. the benefits of the extra minerals so if anyone has any info or experience of this I'd be really grateful!!!

[madmarriedNika]

Kasha, we were in the same boat too with my DS (born at 30 weeks, fed EBM by tube, took a while to regain birthweight of 1.32kg, raised alkaline phosphatase levels)- and to be honest it was explained to me that breastmilk, as wonderful as it is- especially in the case of prems- still cannot mimic what they would have been receiving in utero to grow and thus supplementation is necessary. We consented to the fortifier, which commenced when he was 3 weeks old and was used until we left SCBU aged 8 weeks- he was on bottles of EBM then and after many difficulties I finally go him to BF directly from me just after his due date. He then didn't have a drop of formula until 10.5 months old!

Yes it is a shame that the fortifier contains cows milk BUT I think the proteins are hydrolysed- in doing so they cannot cause allergies such as lactose intolerance (in fact the formula milks for babies who are lactose intolerant are often based on hydrolysed cows milk- as soy can be a bad alternative esp. for boys).

I think the fortifier did help my DS gain weight a lot faster and solved the alkaline phosphatase prob too. Now, aged 3yrs, he doesn't have any probs at all (except eczema...but he is not allergic to cows milk- has been fully allergy tested). My one recommendation if you are concerned re potential allergies is when you get him home start giving him probiotics (e.g. Acidophilus powder, which are suitable for babies (well, DD's consultant let us use it from birth)- see: www.yourhealthfoodstore.co.uk/details.php/p1687_biocare_acidophilus_plus_banana_or_strawberry.html) There is quite a lot of research showing that probiotics reduce the incidence of allergies- as well as helping with wind, colic etc. which premmies are prone to.

Well done with the breastfeeding and I really hope your DS2 has a smooth ride through SCBU & you're all home together soon. Thinking of you- it's a tough time x

[KashaSarrasin]

Thanks Nika and glad to hear your DS is now doing well .

Yes, the proteins are hydrolysed, but someone on another board suggested there was still an increased risk of necrotising enterocolitis with the fortifier. I've searched PubMed and can't find much apart from this paper which suggests increased risk of E coli etc. It doesn't tell me whether that's worse than the risk of metabolic bone disease though!

I'll check out the probiotics, thanks for that.

[madmarriedNika]

Kasha,

yes sorry in my dopey state I had neglected to comment on the risk of NEC. I know that babies receiving breastmilk have a much lower risk of developing NEC and can see how adding a fortifier may affect the natural antibiotic properties of breastmilk. We never had any real option though for my DS, the only fortifier available was cows milk derived, and his need to supplementation too great to continue on unfortified breastmilk. It's a very hard decision. If I remember correctly DS didn't have all his feeds fortified- I think it was every other- perhaps this was to minimise risk of NEC...

Good luck x

[KashaSarrasin]

Thanks again Nika

DS2 started on the fortifier last Friday. He had blood tests on Monday that showed his alk phos was already down to 300 something, so I suspect the levels were already on the way down . Now he's being kept on it to help with weight gain, which has slowed [sigh] but I'm hoping he'll be off it completely soon. At least now he's been taking more feeds directly from me and there's no fortifier in them!!