Leanne has asked for resources for when to supplement with formula. 
Start with the Academy of Breastfeeding Medicine's supplementation 
protocol at www.bfmed.org. Also helpful will be the Model Hospital 
Policy Recommendations at 
http://www.cdph.ca.gov/healthinfo/healthyliving/childfamily/Pages/MainPageofBreastfeedingToolkit.aspx. 
The AAP has a sample breastfeeding policy at 
www.aap.org/breastfeeding/samplehospitalpolicy.pdf.

One way that hospitals have been able to gather data on how much and 
why supplementation was happening as well as get it under control is to 
lock up the formula and require staff to log out each bottle with the 
date, time, batch number, patient, staff person, and reason for use. 
Another method is to put formula in a medication distribution system 
such as Pyxis. This helps staff use the product only when appropriate 
and prevents the hog wild supplementation that is occurring in so many 
institutions. The amount to supplement can be calculated by weight, 
with 3-5ml/kg/feed as a reasonable starting point or some units use 
5-10ml/feed on day 1, 10-20ml/feed on day 2, and 20-30ml/feed on day 3. 
This is based on the volume of the newborn stomach, the amount of 
colostrum that is normally available to the infant (but which he cannot 
for some reason remove), and the average amounts of breastmilk ingested 
as measured on each of those days.

Marsha Walker, RN, IBCLC
Weston, MA

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