Dear Barbara and Kay:
My facility has guidelines re: newborn stomach capacity for infants requiring supplementing. Day 1: 5-7 ml, Day 2: 12-17 ml, Day 3: 22-27 ml, Day 4: a whopping 60-87 ml!!
I am looking for scientific evidence to support my claim that the current amount recommended for Day 4 is too much for most newborns. Can you provide your guidelines and any other references?
Caitriona Finn, RN IBCLC
Oct 25, 2010
Thanks for your question about appropriate volumes of supplementation for newborns on Days 1-4. Sensitive scales, validated weighing protocols, and better understanding of normal infant growth parameters are helping to create an evidence-basis for early supplementation based on physiologic values for breastfeeding infants.
Healthy mothers typically make more milk than the baby removes, especially in the first few days. Some studies look at milk production; others look at infant intake. These are two different issues. Not understanding this can produce confusion. Supplementation should be based on physiologic infant intake amounts, not necessarily the volume of milk a normal woman is capable of producing.
Data for Day 1 intake volumes have been scarce owing to many decades of routine maternal/child separation and restrictive feeding policies. A study published in The Journal of Pediatrics (2010) examined the range of colostrum intake in 90 normal, term infants during the first 24 hours. A total of 307 feedings were evaluated using scales with 0.5 g sensitivity. The results identified the “mean weight gain per breastfeeding was 5.0 + 3.6 g. (range 0 to 6.6 g)” on Day 1.
The amount of available colostrum rises on Day 2 to about 175 to 200 ml/day (Lawrence 2005). Breastfeeding infants on Day 2 generally consume, on average, about 12 ml/per feeding (Wang 1994).
The onset of copious milk production occurs between 30 to 72 hour. Milk volumes rapidly rise on Days 3 and 4 to about 15-17 oz/day (485-600 ml). Infant intake capacity generally increases as well to approximately 1-2 oz/feeding(30-60 ml).
Supplementation of a newborn is a medical decision, and should be individualized to take into account specific needs depending upon birth weight, weight loss, bilirubin levels, blood sugars, etc. Therefore, all supplementation guidelines are by nature, somewhat general.
An excellent resource to provide an evidence basis for supplementation of newborns can be found in the Academy of Breastfeeding Medicine’s Protocol #3.
The chart (below) summarizes the ABM protocol’s suggested supplementation volumes. Based on the ABM recommendations, your unit policy does appear to reflect somewhat high volumes for supplementation on Day 4.
TABLE 3. AVERAGE REPORTED INTAKES OF COLOSTRUM
BY HEALTHY BREASTFED INFANTS
Time Intake (mL/feed)
1st 24 hours 2–10
24–48 hours 5–15
48–72 hours 15–30
72–96 hours 30–60
From: ABM Clinical Protocol #3, Revised 2009.
Academy of Breastfeeding Medicine Protocol Committee. ABM Protocol # 3. Hospital Guidelines for the Use of Supplementary Feedings in the Healthy Term Breastfed Neonate, Breastfeeding Medicine 2009; 4(3):175-182. http://www.bfmed.org/Resources/Protocols.aspx
Lawrence RA, Lawrence RM. Breastfeeding: A Guide for the Medical Profession (6th ed). Philadelphia, PA: Elsevier Mosby, 2005; pp. 99-100. (see chart on p. 100)
Neville M, Keller R, Seacat J, et al. Studies in human lactation: milk volumes in lactating women during the onset of lactation and full lactation. American Journal of Clinical Nutrition 1988; 48(6):1375-86.
Santoro J, Martinez FE, Ricco RG, et al. Colostrum ingested during the First Day of life by exclusively breastfed healthy newborn infants, The Journal of Pediatrics 2010; 156:29-32.