Human milk fortifiers are milk supplements and not actually meant to substitute for the breast milk itself. They are meant for gradual inclusion to the child's nutrition as it grows older and start having the need to advance in feeding. These fortifiers should as well have the basic and very important nutrient as the breast milk. So what are they?
Indications for use and characteristics
• Nutrient supplement designed to supply additional calories, protein, calcium, phosphorus, zinc and other vitamins and minerals to premature breastmilk.
• Designed for infants less than 34 weeks gestation or those less than 1500g at birth once feeding has reached at least 75% full volume feeding with expressed breast milk.
• Enfamil Human Milk Fortifier (HMF) is mixed to 24 calories per ounce by adding 1 packet (3.8g) to 25 cc expressed breast milk. Adding HMF to breast milk will increase the osmolality. Adding HMF to breast milk will increase the osmolality to greater than 350 mOsm/L, which may cause gastrointestinal disturbances or feeding intolerance.
• Similac Natural Care is a liquid fortifier that can be mixed in any desired proportion with breastmilk. (typically 1:1 with breast milk) or fed alternatively with breast milk feedings. Due to the reason that this fortifier is a liquid, adding it to breast milk is ideal if the mother's milk production is low. Similac Natural Care has an osmolality of 280 mOsm/L
How to feed a Newborn
Position- football hold, supported by pillow, mother's back and arm supported by pillow. Baby should be able to see mother's face in this position. Length of feeding- 10-15 minutes on each breast, longer amounts of time will lead to sore nipples, tired baby and frustration for mom and baby.
Number of daily feedings- the number of feedings required per day decrease throughout the first year.
First 2 months of Life: 7 feedings per day every 3 hours with night break in 6 hours (schedule: 6:00, 9:00, 12:0, 15:00, 18:00, 21:00, 24:00).
3-4 months of life: 6 feedings per day every 3.5 hours, with night break in 6.5 hours (schedule: 6:00, 9:30, 13:00, 16:30, 20:00, and 23:30).
5 months- 1 year: 5 feedings per day every 4 hours, with night break in 8 hours (schedule: 6:00, 10:00, 14:00, 18:00, and 22:00).
These are just examples on very good timing on breast feeding.
Method of estimation of daily volume of food
Volume of milk (in ml per day) is equal:
• 2-8 weeks: 1/5 of baby's weight (in grammes)
• 8weeks to 4 months: 1/6 of baby's weight (in grammes)
• 5-6 months: 1/7 of baby's weight (in grammes)
• 6 months to 1 year: 1L/day.
Daily volume of food must not be more than 1000ml!
Caloric method
• 1-3 months: 125kcal/kg/day
• 4-6 months: 120kcal/kg/day
• 7-9 months: 115kcal/kg/day
• 10-12 months: 110-105kcal/kg/day
1 liter of human milk has 700kcal.
Estimation of daily volume of food for child of the first 10 days of life
Formula by Finkelshtein:
Volume of milk (in ml per day) = days of life X 70; if the baby's birth weight was 3200g and less.
Volume of milk (in ml per day) = days of life X 80; if the baby's birth weight was 3300g and more.
Another formula suggests the estimation of the volume of needed breast milk of a newborn within this period as: 2% of baby's birth weight X n: where n is the number of days of baby's Life.
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