I've tried researching this too and found that there is virtually no research in this area to back up the practice of large volumes fed to preterm infants in the first 48 hours. The AAP actually gives very little information on appropriate volumes in the first couple days for term or preterm babies. I couldn't even find anything on recommended formula volumes for parents. AAP formula recommendations start at one week. It's just habit and misinformation passed down from one person to another and not based on science. The Pediatric Residency Breastfeeding curriculum, in the Management of Common Breastfeeding Situations Powerpoint:For Term babies:Small volume is normal:7-123 ml/day first day2-10 ml/feeding day 15-15 ml/feeding day 2
Also in the AAP model hospital policy they have listed: Expected feeding volumes in first 2 days (1–2 tsp or 5–10 mL/feed; 1–2 oz/d, term newborn)
I've often wondered, if this is normal volume for full term baby - why would we feed 20 to 30 ml to a preterm infant that is only 4 pounds? 
I have the same problem where I work. Just yesterday talking to a family with a term baby in the NICU for respiratory distress and baby is less than 48 hours old, basically healthy now and just on observation. By some miracle this first time mother was pumping 15 ml per pump session but the baby has been getting 20 ml formula per feed from day 1. So Day 1 was all formula and now still partly formula. The mother is really not wanting to give formula and the baby is spitting it up and not tolerating it well. But the NICU isn't happy with the 15 ml colostrum, they want another 5 ml on top of it and going to 30 ml the next day. I don't know why the Pediatricians are fine with the small amounts of colostrum for a 7 lb baby but the Neonatologists are ordering 20 ml on day one for a 4 lb baby. So yes, you are right, it is crazy and no there is no research to back up that practice, especially when you have an IV so baby isn't going to get dehydrated. I think the above volumes are even pretty high. It's rare that I get a mother that can express those amounts, especially a first-time mother. Women who've had many children tend to make more colostrum sooner, I find. We typically feed whatever mom can get for healthy term babies who are not latching, which is typically 0.5 ml to 2 ml per hand expression (but more if we can get it). Unless we see some other sign of a problem; dehydration, jaundice, hypoglycemia, etc. Here is the largest, well-controlled study on colostrum intake during the first 24 hours.
https://www.ncbi.nlm.nih.gov/pubmed/19783000

I think the ABM supplementation guidelines need updating I think because for their volume recommendations they use several studies from the 1980's that just look at the size of the baby's stomach and not the amount of colostrum that the mother produces. This may be where some the MD's getting the idea that they should feed 20 ml/per feed on day one - the stomach capacity. There are many LC's now that say that the baby's stomach size on day 1 is 5-7 ml but Nils Bergman disputes this and I think he may be right. It is possible that the baby's stomach may hold more milk, but that doesn't mean it is a normal feeding for the baby. We shouldn't be going by the maximum amount of food that the stomach will hold. That's a mistake, I think. The real question should be what is the normal amount of milk the breast produces on day 1! There is no science to back up the idea that the baby is intended to have a feeding on day 1 that completely fills their stomach. In utero, the baby is normally drinking up to 500 ml amniotic per day prior to delivery, small amounts at a time, but probably filling stomach to about 20 ml. However - this does not mean they are meant to drink 20 ml of colostrum on day 1. We need to look at what is normal for the body to produce and normal amount of colostrum for baby to drink when we think about how much they should be eating. This is what 300 million years of evolution has created for them and we should not be deviating from that. We really need more studies on this. Someone please do a study and include Day 2 because I think the volume actually goes down on day 2 for many women. I think this lower volume is driving the babies to nurse more and with a stronger suction which brings their milk in faster. But that is just my theory.
Tricia Shamblin, RN, IBCLC



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