The various opinions and stats on this topic have been most interesting. Jan
wrote, " But if the baby isn't gaining well (for whatever reason), or is a
preterm baby, and the powers that be have determined that said baby needs x
number of cc of breastmilk or he will be supplemented with x number of cc of
formula, wouldn't it be helpful to know, at least generally, how many
calories his mom's breastmilk is so the amounts could be adjusted
accordingly?"

While I agree it would be nice to know exactly how many calories the baby is
receiving, the real test, surely, is whether the baby *thrives*.  I saw a
mom in the Neonatal Unit today to assist with teaching a premie to latch and
breastfeed. Baby had been born at 25 weeks, weighing 750g.  He is now 2
months old and weighs 1660g.  He currently receives 47 ml EBM every 3 hours,
(that's 225ml/kg/day) which mom feeds by cup during the day.  Baby receives
his EBM via NGT during the night for the convenience of the nurses. He is
now gaining 20g per day which his paediatrician is very happy with.  So he
will be discharged in about a week (at an effective 34 weeks gestation)
weighing 1800g.  This little boy is weighed every 2 days and the amount of
EBM he should receive is adjusted accordingly.

The point is that once a baby is able to digest a particular amount of
breastmilk (i e the stomach empties before the next feed, 2 or 3 hours
later) then the quantity of milk is increased so that these little mites
start gaining really well once they are stable.  No-one would think of
adding calories in the form of ABM unless the mother was simply not able to
express enough (very unusual) they would simply add more breastmilk.  Nor
have I ever heard of a mother being encouraged to discard "foremilk" so that
the baby could receive the higher-calorie "hindmilk" - if a baby is not
gaining on a good quantity of straight EBM (as it comes) the paediatrician
starts looking at other reasons why the baby doesn't gain (e g infection),
treats that, and simply waits for the baby to start gaining again.

This mom has been hand-expressing for two months and I was fascinated to see
how good she was at it - multiple strong jets squirting into the little cup,
and a froth forming, like a milkshake.  It took her all of three minutes to
get the required amount which she then cup-fed to her baby, tipping him over
face-down and smacking him on the back when he choked, and carrying on again
once he had caught his breath, jiggling him around to wake him up so he
would take every last precious drop!

Pamela Morrison IBCLC, Zimbabwe