Jumping in here after days of reading all the various posts...
Marian quoted a textbook of neonatology which contained a table showing
needs of babies of different ages.  I didn't see any references for how this
chart was produced.  Most hospital NICUs have some kind of table like this,
and I have yet to see one that is referenced so a user can find out who came
up with the numbers and how.  In my hospital the table was based on baby's
weight.  The amounts for newborns from day one were staggering, and if it is
one of the babies over 10 pounds (which includes over 10% of Norwegian
babies at this point), they were expected to guzzle down about 10 ounces
(300 ml, I think) in THE FIRST 24 HOURS OF LIFE (yes, I am shouting now).
The typical scenario was that they managed to get the first 40 ml down by
bottle, but when the baby was uninterested 3 hours later, when the next feed
was mandated by the table and the procedure, it would be given by gavage,
and the baby could even get a neuro workup for lethargy.  When the baby
started spitting up before or around the next feed, infection would be
suspected as the cause of the 'feeding problem'.  The problem escalated
rapidly as the volume baby was expected to ingest increased from day to day.

Also, many of the tables were based on amounts of breast milk substitutes
required to provide sufficient energy to support growth.  Since breast milk
is more efficiently utilized, less volume is required to deliver the same
energy value to the baby.  Surprisingly few people, including those working
in NICUs, are aware of this.  Substitutes carry an obligatory energy 'cost'
to the baby.  They are inefficiently digested and metabolized, hence the
smelly poop and increased urine output.  The baby uses more energy to digest
and metabolize these substitutes than for mother's milk.  And this is
without taking into consideration the physiologic cost to the baby of having
to cope with ingesting the food from some vessel other than mother's breast:
more heat loss, and more disruption of cardiac and respiratory function.

Rachel Myr, midwife and IBCLC
Kristiansand, Norway

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