We know that nutrition is the foundation of early developmental promotion for premature babies. However, it is often a problem for new mothers to feed their babies well when they come home from the hospital. Usually, mothers encounter two problems: insufficient breast milk production and insufficient breast milk intake, i.e. one is not enough milk for the mother and the other is not enough milk for the baby. There are many reasons for the lack of mother’s breast milk secretion, such as delayed opening, infrequent sucking or milking, and immaturity of premature babies that do not stimulate the areola suction enough, in addition to the mother’s poor health, changes in the baby’s condition that make the mother nervous, fatigue, anxiety, etc. can also affect milk secretion (moms should know how to work on it). Another problem is the insufficient intake of milk by the baby. We say that breastfeeding and sucking is something that every baby needs to learn, especially the problem of cooperation between mother and baby (poor cooperation is a common reason for insufficient breast milk intake in premature babies). Especially the breastfeeding on the mother’s breast, the immaturity of the oral muscles of preterm babies, or some preterm babies may have impaired oral function due to illnesses caused by the use of ventilators, the maladaptive situation of kissing after bottle-feeding, etc. (Modern ultrasound technology has clearly shown that the oral muscle groups used by the baby are different when breast-feeding and bottle-feeding). The Breastfeeding Consultation Clinic on Tuesday mornings at the Child Health Unit provides guidance on interventions to assess breastfeeding deficiencies and breastfeeding and suckling in preterm infants. Here is another look at breast milk fortification and formula for preterm babies as mentioned in the Code of Practice for the Health Care of Premature Infants. Insufficient breast milk intake for preterm babies includes the amount and composition of milk, meaning that if the baby’s daily milk intake is sufficient, but because of the need to complete catch-up growth to compensate for the congenital deficiency of coming out of the mother’s womb too early, certain components of breast milk that need to be consumed daily will be insufficient, such as protein, fat, zinc, iron, calcium, phosphorus, copper, etc., then the nutritional composition of breast milk needs to be fortified, i.e., the concentration of each ml of milk in The concentration of nutrients in each milliliter of milk should be increased in order to maintain the healthy growth of preterm babies. For this type of low birth weight preterm infants, some elements need to be added to the breast milk, which we call breast milk fortification. It can be said that breast milk fortification is a kind of nutrient supplement to supplement the deficiency of certain nutrients. Now the domestic breast milk fortification is still cow’s milk source, later there will be breast milk source. What kind of premature babies need to be fortified with breast milk fortification after discharge from the hospital? Generally, for preterm infants with gestational age <34 weeks and birth weight <2000g, breast milk fortification (HMF) can be used, but growth status should be evaluated before use (based on the growth curve chart below). A gentle reminder: breast milk fortification must be added to breast milk for use! Special attention should be paid to the fact that the addition of breast milk fortification to formula is also prohibited, as this may cause severe metabolic load in infants. About formula for preterm infants The "Code of Practice for the Health Care of Premature Infants" stipulates the method of formula feeding after discharge from the hospital. Preterm infants of appropriate gestational age whose weight for corrected age does not reach the 25th percentile and preterm infants younger than gestational age who do not reach the 10th percentile require continued nutritional fortification after discharge. When the above physical growth standards are reached, the energy density of the fortified nutrition should be gradually reduced, and the growth rate and blood biochemical indicators should be closely monitored during the period until it is discontinued. The post-discharge formula (PDF) is required for preterm infants to continue catching up with growth after discharge from the hospital. One thing to be clear is that preterm formula and preterm transition formula (or post-discharge formula for preterm babies), i.e. the preterm formula we usually buy in the store, are two different things, with different main nutrients. Premature formula is mainly used in hospitals for premature babies with gestational age <34 weeks and birth weight <2000g during hospitalization. Misconceptions Some moms may say can they just use a higher energy formula to make their baby gain pounds? Our answer is no! Excessive intake of energy, protein and other nutrients can increase the metabolic load and may cause other more serious problems. So, the milk supplied to preterm babies is never the more energy and nutrients the better, but the best fit is the best! Breast milk is the first choice, followed by breast milk + breast milk fortification, and formula for preterm babies is the last resort. If a mother's breast milk enables her preterm baby to achieve the ideal catch-up, exclusive breastfeeding is the most suitable and no breast milk fortification (HMF) is needed. For example, if the baby's gestational age is more than 32 weeks or the birth weight is more than 1500g, if they can consume at least 180ml/(kg.d) of the preterm mother's breast milk, i.e. more than 360ml of breast milk a day, there is no need to add fortification and continue to use exclusive breastfeeding. However, the feeding of preterm infants involves many issues, such as gestational age, weight, whether it is SGA (weight less than what a child of that gestational age should be), the issue of catch-up growth, the treatment and rehabilitation of accompanying diseases, and the addition of complementary foods later on, which need to be evaluated by a professional pediatrician.