how can we estimate and subtract breastfeeding volume in a newborn taking intravenous fluid ?

We don't measure breastfeeding volumes in infants given iv fluids or enteral NG tube feeds, but we make some assumptions.

During the first 1-2 days of life, we don't take colostrum volumes into account at all, especially if the infant is just make some attempts to breastfeed.

Later and when on NG tube feeds, we make a pragmatic plan and reduce the NG tube volumes with a reasonable volume.

"Reasonable" in terms of ml? For a term infants with vigorous breastfeeding attempts we may reduce NG tube volumes withs with 1/3 per day (i.e. aim to take the NG tube out within 3 days). For a preterm infants, we usually reduce the NG tube feeds with 5-10 ml/feed after a good breast feeding attempt in preterm infants.

 

Thank you

If fluid intake is of concern, could one test-weigh the infant pre- and post- breastfeed? This would not be realistic during the 1st few days of life

@chantal - do you check pre/post-feed weights in your NICU? We used to do it some years back but stopped as we felt it added more figures than guidance... Would be great to hear your experience.

My observation : there are problems in electronic weight measurements.

Good evening all, in our centre in UMTH-Maiduguri, Nigeria SCBU, whether term baby or Preterm baby, we start with taste feed commemcing it at 20ml/kg body weight per day divided every 3 hrly feed and advance at the same rate if the child tolerate. The taste feed actually given to the preterm is to prime the gut. These depend pretty much on the gestation of the preterm, until the 4th-5th day/when there no residue after each feed.

Dr Simon Pius Neonatologist University of Maiduguri Borno State, North-eastern Nigeria . simonpius2000@yahoo.co.uk, simonp@unimaid.edu.ng

If fluid intake is of concern, could one test-weigh the infant pre- and post- breastfeed? This would not be realistic during the 1st few days of life

Pre- and post-weigh for breastfeeding need to be done in a very "exact" manner. Also you need a scale that gives you an average weight after a certain period of time, e.g., 10sec, computed from the number of readings taken during that time, as the baby  likely will be moving. We have been using the Medela test weigh scale. The important detail is to weigh the infant pre- and post with the same clothing, diaper, etc... Do not change diaper if dirty. Do not add or remove anything baby had on  at the start.

It is used by the NICU milk bank at our hospital, Texas Children's Hospital/Baylor College of Medicine in Houston TX for many years. It is convenient for mothers breastfeeding in the NCU as they know how much baby has taken.  The test-weight is used as intake in their medical chart. Some mothers who are worried about intake at home, will rent such a scale. I believe they can get it from our milk bank. With 1gm = 1ml it is very convenient.

I have attached the article from Paula Meier 1996 which "validates" the technique.  in Paula's article, she described a different scale. 

Hope this helps. 

Meier et al'96 TestWeigh.pdf