Hi Jan
I see the reason for your concern about possible
over-supplementation. However, this protocol would be used for
sick/prem/compromised babies in the NICU who are not breastfeeding at
all, and whose metabolic requirements would be high. Thus a healthy,
full-term baby of 3.5kg baby would normally be breastfeeding, and we
wouldn't know how much he was taking. But if he was assessed as
sick/compromised at birth, the mother would need to be expressing all
she could on Day 1, and he would be topped up with formula to the
total quantity of about 25ml every 3 hours on Day 1, rising to 40ml
every 3 hours on Day 3, which sounds rather a lot, but nevertheless
he would need it. However by the same token, a 950g baby in the
neonatal unit would only need 85ml/day that the paediatrician would
be calling for on Day 3, and his mother would easily be able to
express about 10ml for him every 2 hours, right?
Challenged babies have different requirements from those of healthy
babies - it's all relative. No-one got excited by the normal-weight
babies who took a little longer than usual to establish
breastfeeding. The mother would be advised to start hand-expressing
frequently what she could from about the second day, and
spoon-feeding it to the baby until they got things together.
Pamela
------------------------------
Date: Thu, 3 May 2012 12:34:12 -0400
From: [log in to unmask]
Subject: Supplementation amounts for non-bf babies
Pam discusses some of the written and other protocols for feeding babies
who aren't directly nursing...
<<Day 1-2, 60ml/kg/day
Day 2-3, 90ml/kg/day
Day 3-4, 120ml/kg/day>>
Those were the peds protocols in her community in Zimbabwe. I find these
amounts HUGE for a newborn. Santoro's study in 2010 found that babies in
the first 24 hours of life took approximately 1.5 ml / feed or 15 ml/24
hours.
<Babies who weigh 2.5 kg or more:
150 ml milk per kg body weight per day.
Divide the total into 8 feeds, and give 3-hourly.>
Depending on the size of the baby, for example, a 3.5 Kg baby would be fed
at least 2 ounces from the first feed on the first day on.
Why aren't we going by the average amount of colostrum we know babies get
in the first couple of days? If the baby is supplemented with this amount
for the first 24 hours, and then learns to latch and breastfeed, is he going
to be happy with the small amount of colostrum he is receiving from his
mom if he has had thanksgiving dinner meal after meal he first 24 hours???
Jan Barger, RN, MA, IBCLC, FILCA
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