Denise, thank you for your support with the special baby I am working with.
I'll send an update to Lactnet later, but wanted to answer Denise's query
about the quantity of EBM that I had recommended, "My query is about the
quantities of breastmilk you've suggested. Current literature averages daily
intake in the first 24 hrs as something like 48 ml total for the 24 hrs.
Obviously if you've got the advantage of more colostrum than that then I,
too, would give as much as I could get. It's just the expectation that a
woman must produce 210ml (av 3.5kg baby x 60ml) of colostrum in her first
day that I have problems with."

Yes, Denise, you have made a good point - that most women would not produce
this large volume of breastmilk on the first day after delivery.  However, a
healthy, full-term newborn is different from a sick/prem/high-need newborn
and I notice that the feeding protocol adopted in the Neonatal Units of the
hospitals where I visit reflect this difference.  A healthy full-term baby
is simply offered the breast "on demand" and no-one checks very much to see
the quantity that the baby is ingesting unless or until the mother or the
baby become anxious about it.

However, a baby sick enough to be admitted to the Neonatal Unit is in a
different category altogether.  The paediatricians have slightly different
feeding protocols, but generally - for a baby who is assessed as healthy
enough to receive oral feeding - the guideline is to feed 60 ml/kg/day for
the first 24 hours, then 90/ml/kg/day on Day 2, then 120 ml/kg/day on Day 3,
then 150 ml/kg/day on Day 4. The rationale is that a
sick/prem/asphyxiated/compromised baby needs to maintain normal blood sugar,
fluid intake etc.  The babies in the NNU are always individually assessed
and their feeding individually tailored, so they may receive less than this
sometimes, if aspiration after 2 - 3 hours shows that the baby is not
digesting this quantity, or for other reasons.

You are quite right that the mother may *not* be producing this quantity of
milk in the first 48 hours or so, and if she is not, then the baby will
receive whatever EBM/colostrum is available and will be topped up to the
required amount with formula every 2 - 3 hours depending on the
size/condition of the baby.  However, mothers are encouraged to express as
soon as the baby needs feeding and it is expected that the formula top-ups
will be phased out within 2 - 3 days.  In practice, some of the very tiny
babies are *not* receiving oral feeds before the mother is producing
sufficient EBM, and the quantities of EBM required may be very small, so
that they may never need formula supplements at all.

I wouldn't suggest that *all* babies need this much milk in the first day or
two after delivery.  But because the baby I was working with had very
special difficulties, and because he had only just been discharged from the
NNU, I gave recommendations about the quantity of EBM I thought he would
need based on what would have been required by a sick/prem/special need
baby.  I hope this clarifies.

Pamela Morrison IBCLC, Zimbabwe
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