Kirsten Berggren,

Please send me the pdf of that study to [log in to unmask]  Sorry I did
not send this to your private email, but I don't know it and lacnet sends
back to the list by default.

Warmly
Ann Marie Mackin, LLLL, CLC, WIC PC, (IBCLC hopeful :)


-----Original Message-----
From: Lactation Information and Discussion
[mailto:[log in to unmask]] On Behalf Of Kirsten Berggren
Sent: Wednesday, March 14, 2007 3:16 PM
To: [log in to unmask]
Subject: Infant stomach size reference, 2001

I like Gonneke's take on stomach capacity - that if we start with a false 
assumption (q3h feeds) we end up with a faulty outcome (feeds must be 3oz)!
To counter this false presumption, I have found a more recent reference, 
Zangen et al., Rapid maturation of gastric relaxation in newborn infants. 
Pediatric Research, 2001, 50 (5): 629-632. (I have a pdf of the article that

I can email if anyone needs the whole thing.) The findings primarily discuss

that gastric relaxation becomes greater with each feeding after birth - 
however, the methods used also measured the gastric volumes it took to fill 
the stomach to the point where the maximal pressure was 30 mmHg. By 
comparison, adult volunteers felt initial perception of something in their 
stomach at 23mmHg and felt pain at 26 mm Hg (small range from first feeling 
food to feeling pain, isn't it?). The researchers stopped inflation at any 
signs of discomfort (facial grimace or retch), or when they reached 30mmHg.
The volumes that it took to achieve the 30 mm Hg maximal pressure ranged 
from... (drumroll please)...  38 to 76 ml.
But don't stop with these numbers !!!! From here, we have to back away from 
that volume by 1) the amount the baby took at the breast (test weights could

be helpful here) and 2) the fact that we are not going for maximal distended

pressure - right?!?
The analysis was done in the first week of life, and at some time point 
between the first and 20th feeding, with the gastric relaxation steadily 
increasing correlated closely with age and number of feedings. So - we can 
probably assume that the capacity at the first feeding will be closer to 38 
ml (remembering that this is at point of pain), while when we get to the 
20th feed or 7th day of life, we'll be closer to 76 ml (at point of pain).

It would be worthwhile to contact the authors and see if someone could mine 
their data for information on infant stomach capacity in these first 7 days 
of life. I know that they recorded the volumes as they went, but it was not 
presented in the paper, which really focuses on the development of gastric 
relaxation, and the fact that the relaxation response is different in 
neonates than in adults (who apparently have a plateau in pressures as you 
add more and more volume, after which the pressure again increases - 
neonates do not have this plateau, and have a much more linear relationship 
between volume and pressure). I don't really have time to pursue the 
correspondence with them right now, but would be happy to help anyone who 
can track down the data with interpretation...
Here's the affiliation information as listed on the header of the paper: 
SAMUEL ZANGEN, CARLO DI LORENZO, TSILI ZANGEN, HOWARD MERTZ, LENORE 
SCHWANKOVSKY, AND PAUL E. HYMAN Pediatric Gastrointestinal Motility Center, 
Children's Hospital of Orange County, Orange, California 92868, U.S.A. 
[S.Z., T.Z., L.S., P.E.H.]; the Children's Hospital of Pittsburgh, 
Pennsylvania 15213, U.S.A. [C.D.L.]; and Vanderbilt University, Nashville, 
Tennessee 37232, U.S.A. [H.M.]
Hope this is helpful!!

Kirsten Berggren, PhD, CLC

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