Breast milk fortifier

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Information for when you are feeding your baby at home.

What is this information about?

This information is about using breast milk fortifier as part of your baby’s feeds when you are at home. It explains:

• what breast milk fortifier is
• why we have recommended that you include breast milk fortifier in your baby’s feeds at home
• the side effects that your baby may get from breast milk fortifier
• how much breast milk fortifier you should give your baby
• how you should prepare breast milk fortifier
• what times of the day you can give your baby breast milk fortifier
• what you should do if your baby is sick (vomits) or has diarrhoea (watery poos) when they are having breast milk fortifier
• how you can get supplies of breast milk fortifier when you are at home
• where you can get further information and support.

Why have I been given this information?

Congratulations on choosing to breast feed or to give your baby expressed breast milk at home.

You have been given this information because we recommend that your baby has feeds of expressed breast milk mixed with breast milk fortifier (BMF) as well as breast feeding. This will help them to get the nutrition they need to grow and stay healthy.  

Reading this information will help you to prepare BMF in the right way and feed it to your baby safely.

Why does my baby need BMF?

Your baby needs extra nutrition because they were born preterm. BMF helps them to get the nutrition they need.

Preterm babies are not able to build up the stores of nutrition in their body during the last months of pregnancy in the way that term babies do. This is why they may need extra nutrition after they are born to help them to grow and have strong, healthy bones.

BMF gives your baby the protein, energy (calories), vitamins and minerals they need to grow and develop.

What is breast milk fortifier (BMF)?

When a food or drink is ‘fortified’ it has things added to it to boost the nutrients it contains.

BMF is a powder that you dissolve into breast milk. It gives your baby the extra protein, energy and nutrients that they need because they were born preterm.

Breast milk fortifier is:

• made from cows’ milk. The milk is broken down (hydrolysed) to make it easier for your baby to digest and absorb.
• fortified with nutrients including vitamins and minerals
• made in a way which makes sure it is safe for your baby.

Does BMF have any side effects?

A few babies may find it more difficult to digest their milk feeds completely when the fortifier is added. This may mean that when your baby starts BMF their poos may become ‘looser’ or that they bring up a little bit more milk.

These symptoms do not usually last for long. Your neonatal team will check your baby to make sure they are ok if they have these symptoms.

There is no evidence that using BMF causes allergies or any other conditions.

Why have you asked me to continue to give my baby BMF at home?

Your baby still needs BMF when you go home to help them:

• catch-up with growth that they missed out on by being born preterm
• to grow if they were small for their gestational age.

How many BMF sachets should I use per day?

They should have:

• at least 8 breast feeds in every 24 hours

and

• expressed breast milk (EBM) fortified with BMF as bottle feeds.

Please print off the PDF version to fill in this form. 

___ x 1g Nutriprem BMF sachets in every 24 hours.

___ ml of EBM + BMF in every 24 hours.

You can choose how to give this volume to your baby over the day.

They can have it after a breast feed as a top-up or as a separate bottle feed of EBM + BMF.

How should I prepare (make-up) fortified breast milk feeds?

You will need:

• BMF 1g sachets. Check the expiry date. Do not use them if it is past the expiry date.
• sterile bottles. You will need 3 to 4 of these. They can be washed and re-sterilised.

Instructions:

1. Before you start, make sure the work surface in the kitchen is clean and dry.
2. Wash your hands with soap and water.
3. Express your breastmilk in your usual way. If you are using expressed milk (EBM) which has been stored in the fridge or freezer let it reach room temperature before you add BMF.
4. Measure 25ml of EBM into a bottle
5. Add 1g of BMF to the 25ml of EBM in the bottle (or you can add 2 g sachet to 50ml for larger feed volumes)
6. Swirl the bottle gently until the BMF has dissolved in the EBM.

What time of day should I give the fortified breast milk?

You can give your baby fortified breast milk at any time of the day or night. You may find it easier to give bottles during the day.

For example, if your aim is to give 100ml of EBM + BMF you could give your baby four fortified breastmilk feeds alongside 4 breastfeeds. That would be four feeds of 25ml.

There is no set pattern that you should follow as long as your baby gets the right amount of fortified breast milk. You will find a feeding pattern that is right for you and your baby.

How long might I have to continue to give my baby BMF for?

Your baby’s health visitor, outreach neonatal team and dietitian will check your baby’s growth. They will advise you when you can reduce the amount of BMF that your baby is having.

You are likely to need to give your baby BMF until they have caught up with their growth or they are tracking along a centile line and thriving.

Should I carry on using the BMF if my baby becomes unwell with vomiting (being sick) or diarrhoea (watery poos)?

Your baby is not likely to be sick or have diarrhoea because they are having BMF. 

If they are unwell with sickness or diarrhoea:

• continue to breastfeed
• stop giving them BMF. You can restart it when they are well.

Where do I get supplies of BMF from when I am at home?

We will give you a box of 50 sachets of BMF to take with you when your baby comes home from hospital (is discharged from hospital).

After that, you can only get the BMF (Aptamil Nutriprem Human-Milk Fortifier) with a prescription from your GP.

When your baby is due to be discharged the neonatal unit will give you a letter to give to your GP. This tells your GP that your baby needs a prescription for BMF.

Once your GP has written the prescription you should collect it from your GP surgery and take it to a pharmacy of your choice. They will order the BMF for you.

Who can I contact if I need further information or support after I have read this information?