How to fortify breastmilk when necessary?

When you are a pumping mom, life can be hard. Not only are you taking care of a newborn but having to pump around the clock as well. So, it can feel like double duty, pumping and feeding a bottle. A lot of NICU moms must fortify breastmilk to increase the number of calories for their premature babies. It can feel overwhelming, but you are not alone, and you are doing an awesome job caring for your baby.

Fortifying breastmilk is used very commonly with premature infants. There are so many reasons to increase calories in breastmilk for babies. A common one is that the consumption of volume is less than optimal so increasing calories can balance the babies’ caloric needs. Fortifying breastmilk should always be done under the direction of a doctor. There are side effects of increasing the calories such as GI intolerance. 

There are two options when fortifying breastmilk: use human milk fortifier or formula. Human milk fortifier is made from donor breastmilk that has been pasteurized and concentrated human milk to be used as a fortifier. Breastmilk is on average 20 calories per ounce, and this is the assumption we use when calculating for mixing. Your doctor will determine the calories per ounce to feed your baby for optimal growth and development. 

To increase breastmilk to 22 calories, use 3 ounces of breastmilk and ½ teaspoon of formula. To increase breastmilk to 24 calories per ounces, use 5 ounces of breastmilk and 2 teaspoons of formula. To increase breastmilk to 26 calories per ounces, use 5 ounces of breastmilk to 1 tablespoon of formula. 

When my third baby was in the NICU, his breastmilk was fortified to 24 calories. When he was discharged, we were fortifying to 22 calories. When you are fortifying it can be helpful to use a formula pitcher. My favorite is the Dr. Brown’s pitcher. When adding formula to the breastmilk it takes a bit of aggressive mixing to have it dissolve in. When you shake the milk, it can increase the gas bubbles and cause your little one to be uncomfortable with gas and colic symptoms. It is important to throw out any remaining milk after a baby feeds. So, using a pitcher can help you make bottles quickly and then add in a bit more if baby needs a top off. Milk that has been fortified has to be used in 24 hours after fortifying.

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