THE JOURNAL OF PEDIATRICS

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Vol. 156, No. 6 Shaul Dollberg, MD Department of Neonatology Tel Aviv Sourasky Medical Center Tel Aviv, Israel Francis B. Mimouni, MD Department of Pediatrics Shaare Zedek Medical Center Jerusalem, Israel
10.1016/j.jpeds.2010.02.022

2. American Academy of Pediatrics, Committee on Genetics: issues in newborn screening. Pediatrics 1992;89:345-9. es PKR, Turcato MDF, Angulo IDL, Maciel LMZ. Neonatal 3. Magalha o Preto School of screening program at University Hospital of Ribeira de Pu blica (Rio de o Paulo University, Brazil. Cad de Sau Medicine, Sa Janeiro) 2009;25:445-54.

Milk volume on the rst day of life

To the Editor: We read with interest the article by Santoro et al1 on the amount of colostrum ingested during the rst day of life by exclusively breastfed healthy newborn infants. Santoro et al1 wrote that there are no reports correlating the quantity of milk ingested by a healthy and exclusively breastfed infant during the rst 24 hours of life with maternal-obstetricneonatal factors. A Medline search, with the keywords of milk intake rst day, and with the limits of human studies, English only, and age-neonate retrieved 137 articles, including the pioneering 1986 work of Casey et al2 and our own study published in 2001.3 These 2 articles would have allowed Santoro et al1 to compare their results with these other reports. In their study, Santoro et al1 found an average intake of colostrum on day 1 of 15 11 g. With the mean birth weight of 3.1 kg from their study, the day 1 intake was approximately 5 g/kg/d, less than the 13 mL/kg/d published by Casey or the 9.6 mL/kg/d reported by us (assuming specic gravity of human milk of 1.03 g/mL).4 We believe that this difference arises from the fact that Santoro et al1 did not take into account the insensible water loss that occurs during a milk feeding episode.5 The other studies made the appropriate corrections to yield more accurate and higher values. Incidentally, we speculated that the difference of approximately 4 mL/kg/d between our own results and those of Casey et al2 may have been due to the fact that our study, patients were not roomed-in and were fed according to a strict 4-hour schedule. In contrast, the infants studied by Casey et al2 were roomed-in and fed on demand. We were not able to determine whether the infants in the study by Santoro et al1 were roomed-in or not, an extremely important variable in a study of breast feeding. Although Santoros stated goals were to report on the quantity of milk in relation to maternal-obstetric-neonatal factors, they only reported a multiple regression on weight gain and maternal-obstetric-neonatal factors. Weight gain and milk intake are not necessarily the same. Weight gain depends on milk intake and many other variables such as metabolic rate, environmental heat, insensible water losses, urine output, etc. Also, it is unclear from the study how many variables were chosen as independent variables in the regression equation and why. In our study, milk intake correlated strikingly with birth weight both in human milkfed infants and in formula-fed infants.3 This may indicate that the larger the baby, in general the more mature it is. We speculate that more mature infants may also have a more mature suck and swallow mechanism.
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References
1. Santoro W, Martinez FE, Ricco RG, Jorge SM. Colostrum ingested during the rst day of life by exclusively breastfed healthy newborn infants. J Pediatr 2010;156:29-32. 2. Casey CE, Neifert MR, Seacat JM, Neville MC. Nutrient intake by breast-fed infants during the rst ve days after birth. Am J Dis Child 1986;140:933-6. 3. Dollberg S, Lahav S, Mimouni FB. A comparison of intake of breast-fed and bottle-fed infants during the rst two days of life. J Am Coll Nutr 2001;20:209-11. 4. Meymott Tidy C. On human milk. Available at: http://www.neonatology. org/classics/tidy.html. Accessed April 13, 2010. 5. Salarya EM, Easton PM, Cater JL. Duration of breastfeeding after early initiation and frequent feeding. Lancet 1978;2:1141-2.

Reply
To the Editor: We acknowledge the interest of Dollberg and Mimouni in our study on the amount of colostrum ingested during the rst day of life by exclusively breastfed healthy newborn infants. The authors are disappointed with our statement that there are no reports correlating the quantity of milk ingested by a healthy and exclusively breastfed infant during the rst 24 hours of life with maternal-obstetric-neonatal factors, and retrieved 137 articles on the basis of a Medline search. We agree that, by searching with those keywords, the program identies a large number of articles. But by carefully reading the studies we support our statement in the Introduction: Despite the various studies on milk production at the beginning of lactation, there are few measurements of milk production during the rst 24 hours postpartum, and we referred to 3 of these studies.1-3 Dollberg et al4 correlated milk intake with some neonatal factors. Nevertheless, none of the reports correlated the quantity of milk ingested during the rst 24 hours of life with maternal-obstetric-neonatal factors. The pioneering study of Casey et al5 and the study of Dollberg et al4 used a quite different method compared with our study. In the study by Casey et al,5 the weight test was performed by the mother and, as described in their Methods section, All mothers were able to commence test weighing by 36 hours post partum. The results for milk intake from 0 to 24 hours was for 3 infants and ranged from 3 to 32 g/kg. In the introduction of our study we cited a more recent study by Caseys group.6 The article by Dollberg et al4 compared the intake of breast-fed and bottle-fed infants during the rst 2 days of