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From:
Bill & Carol L'Esperance <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Fri, 2 Apr 2010 20:28:55 -0600
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Greetings,
We really don't have much data regarding norms for the first few days of life. Three studies(Yamauchi, 1990; Casey, 1986; Benson, 2001) report feeding frequency in the first 24  hours. Average feeding frequency in these studies was 4.3-7.4. In one study the range in the first 24 hours was 0-11 and in the 2nd was 1-22. Both Bystrova(2006) and Ball(2006) found that babies fed more when they were with their mothers and preferably STS. I forgot to mention in a previous entry that another reason we did away with supplementation in L& D is because we implemented STS for the first hour of life about a year and a half ago. The most interesting aspect when I audited was that babies nursed a lot in L& D, not just once. sometimes as much as 4-5 times! The average was almost 2. 

And that is another thing about norms. Observing babies in the first few days of life, they don't feed every so many hours like when the milk comes in. They definitely feed in clusters feeding more when they are awake.  Sometimes a baby nurses every 10 -15 minutes for several hours. We can count those as separate feedings. I think sometimes the nurses count them as one.

A good example of weak data is the study that we base our norms for sleep patterns in the first 24 hours.  It appears that babies have a recovery period after the first period of reactivity. But the research on that was done in 1966 on babies in the nursery!! Of course babies will sleep in the nursery. Bergman says they are in protest despair! What is normal when babies are skin to skin with the mother? Does STS compensate for the drugs in labor? If a baby does not eat for 24hrs after the feeding in L& D, but is kept STS with the mother and is not disturbed would the weight loss be low? I think sometimes we stress the baby so much that they use calories being stimulated to try to feed!  

The Bystrova study reported that babies who are supplemented do not take overall more fluid (just less br milk). Their total intake was the same as babies who breastfed exclusively!  They had  fewer feedings at the breast. And they take longer to gain their weight back. The supplemented had a delay in recovery of weight loss at day 3-5. And supplementing Near Term babies did not have an effect on weight loss compared to babies who did not get supplemented. 
We do need norms and we do need the study that answers the question, "How long can a term baby go in the first 24 hours without feeding."
It is all so interesting! 
Carol L'Esperance, Albuquerque, NM

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