The fatal flaw of the study on test weighing is the definition of the gold standard.  How did they 
determine milk intake.  This has been studied extensively in the anthropometric literature.  Visual 
inspection of the ml on a bottle is not the gold standard and is not accurate.  Babies dribble and 
spit up.  I have measured the weights of many a bottle and found that the lines used to indicate 
milliliters to be highly inaccurate from bottle to bottle even within the same brand.  

So, this study did not prove ANYTHING about accuracy or precision.  And there is a large body of 
literature in nutritional sciences that these particular neonatologists should read.

In terms of the more important indicator of DEPENDABILITY which means how accurate any 
observation of a feeding is, all tools that we might use to assess the baby are flawed if we only 
observe the baby once.  You can watch one feeding and assume the baby is happy and contented 
and the next feeding the baby may be screaming.  You can measure one feeding and the baby 
might gulp down 4 ounces quickly, but if mom hasn't fed the baby from the breast in 12 hours 
and hasn't pumped, the baby might be riding off the backlog.  And the baby might do a terrible 
feeding the next time.  Or, you might see a baby within two hours after the last feeding and that 
baby might be barely swallowing so you might conclude the baby is not doing well.  But the baby 
may just not be ready to feed.

Any indicator that you use should be put into context of the whole picture over time of how a baby 
feeds.

Best regards, 

Susan E. Burger, MHS, PhD, IBCLC

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