Marsha, I can't see any mention of the relationship between the
amounts recommended per feed and the late preterm baby's birth weight,
nor to the total daily desired intake in your post, from which I quote
the following:

"The amounts recommended are 5-10ml every 2-3 hours on day 1, 10-20ml
per feed on day 2, and 20-30 ml per feed on day 3." (Stellwagen LM,
Hubbard ET, Wolf A. The late preterm infant: a little baby with big
needs. Contemporary Pediatrics. November 1, 2007)

Where I work they start with 5% of body weight as soon as baby is
feeding, *I think*, moving to 15% as baby is able to take in greater
volumes.  Surely the baby's size has some bearing on how much they are
estimated to need?  Are we to assume that the intervals between feeds
remain 'every 2-3 hours' throughout the first three days?  If the baby
is getting 5 ml every three hours, which is possible to do and still
follow these recommendations, it will get 5 ml x 8 for a total 40 ml
total in the first day of life, whereas if the caregiver interprets
the recommendation the other way, and gives 10 ml every two hours, it
will end up being three times as much (12 x 10 = 120). That's a lot of
leeway with no guidance for how to tell which babies can manage on 40
ml and which should be getting more.

One of my major headaches in the hospital is that parents are almost
never given advice in terms of the baby's daily needs when they go
home with a baby who isn't feeding on cue and reliably. They are
instructed to give a very specific amount at each feed, but the issue
of feeding frequency and its effect on total intake is never, ever
mentioned, I think because it is assumed the baby will *be fed* every
three hours.  To my mind this reference is not much more help than
what I'm used to, which is inadequate at best and unsafe at worst.  It
can lead to babies getting underfed or overfed, and it ignores the
need to teach parents what normal newborn behavior is, so they can
tell the difference between hunger and satiety.

Moreover, the beautiful thing about ml per kg per day is that it's so
EASY TO CALCULATE unless you have extra digits or have amputated a few
fingers. Base 10 comes pretty naturally to most of us.  Also, you can
move the focus away from 'getting a minimum amount into the baby every
time' to 'aiming for a total intake of xxx ml in a 24 hour period' and
emphasize that the baby may want to feed at unequal intervals and take
different amounts per time.

Fifteen per cent of 3 kg, which is easier if you call it 3000 grams,
is 0.15 x 3000 = 450.  450 ml is approximately 15 ounces.  Ten per
cent is even easier to figure, even if the baby's weight was something
oddball like 3365 g.  I can not even imagine how I would begin to
calculate approximate daily need in the quaint system I grew up with,
figuring percentages of pounds and how many ounces that translates to.
 No wonder people have trouble.  Good thing we don't need to know how
to figure any of this if BF is working!

Rachel Myr
Kristiansand, Norway

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