Food for Thought: To HMF or not to HMF

After battling CONS in the first few weeks of his hospital stay, my son dropped quite a bit of weight and the doctors were anxious to see his weight trending in the other direction.  Without much discussion, the put him on Human Milk Fortifier (HMF); one pack at first, increasing to two packs within 48 hours.  I attended rounds the day they decided to put him on HMF and no risks or potential side effects of the move were ever discussed.  


Within two days my son had blood in his stool and an xray revealed a lot of air in his intestines.  The doctor sat me down and explained that they were not certain, but had concerns that he was suffering from a very serious disorder called NEC.  One in three babies who are diagnosed with NEC die, so this potential diagnosis was very serious.  They immediately discontinued oral feeds and placed him on fluids to give his gut a rest.  My son did not eat for two days before the next xray revealed that it was not NEC.  They put him on an elemental formula Neocate which he tolerated.  Since it wasn't NEC, they believed that my son had developed a cow's milk protein allergy, possibly because of the early introduction by HMF.  I ended up on a dairy-free diet (which is harder than it sounds) because the protein transfers through breastmilk.  He remained on Neocate for almost 10 days at which time they slowly re-introduced breast milk.  As you can imagine, two weeks of little/reduced feeding really impacted his growth rate and his weight dropped from the 50th percentile to below the 3rd percentile (even on an adjusted chart).  


We were unable to find studies that clearly link HMF to NEC or NEC scares but heard countless stories from other doctors, nurses and moms where there seemed to be an undeniable correlation.  Doctors and parents are in such a hurry to fatten up the baby and supplementing breastmilk seems like the easiest step to accomplish that goal.  And while this goal is understandable, parents need to ensure they understand and consider whether HMF is right for their little ones.  The problem is the young gut often cannot handle cow's milk and even if NEC does not develop, the possible setbacks from a NEC scare should be considered before such steps are taken. 


I wish I had realized at the time the risk associated with introducing cow's milk at such a young age; had I known I would have insisted they push up feeds rather than use HMF.  I would never have let them use HMF on Elie.  If you find yourself in the same boat, speak to the neonatologist and see what other options you have or if you can you try to merely increase volume rather than supplement with HMF.  Breastmilk is easiest to digest and safer for your baby.


The links below provide some additional information for your consideration.  If you find yourself in the same situation, please leave a comment so that others can hear your story. 


http://www.ncbi.nlm.nih.gov/pubmed/17100376
http://pediatrics.aappublications.org/content/114/6/e699



Thanks