THE JOURNAL OF PEDIATRICS � www.jpeds.com Vol. 156, No. 6

2. American Academy of Pediatrics, Committee on Genetics: issues in new-

born screening. Pediatrics 1992;89:345-9.

3. Magalhaes PKR, Turcato MDF, Angulo IDL, Maciel LMZ. Neonatal

screening program at University Hospital of Ribeirao Preto School of

Medicine, Sao Paulo University, Brazil. Cad de Saude Publica (Rio de

Janeiro) 2009;25:445-54.

Milk volume on the first day of life

To the Editor:We read with interest the article by Santoro et al1 on the

amount of colostrum ingested during the first day of lifeby exclusively breastfed healthy newborn infants. Santoroet al1 wrote that ‘‘there are no reports correlating the quantityof milk ingested by a healthy and exclusively breastfed infantduring the first 24 hours of life with maternal-obstetric-neonatal factors.’’ A Medline search, with the keywordsof ‘‘milk intake first day,’’ and with the limits of ‘‘humanstudies,’’ ‘‘English only,’’ and age-‘‘neonate’’ retrieved 137articles, including the pioneering 1986 work of Casey et al2

and our own study published in 2001.3 These 2 articles wouldhave allowed Santoro et al1 to compare their results withthese other reports.

In their study, Santoro et al1 found an average intake ofcolostrum on day 1 of 15� 11 g. With the mean birth weightof 3.1 kg from their study, the day 1 intake was approximately5 g/kg/d, less than the 13 mL/kg/d published by Casey or the9.6 mL/kg/d reported by us (assuming specific gravity ofhuman milk of 1.03 g/mL).4 We believe that this differencearises from the fact that Santoro et al1 did not take intoaccount the insensible water loss that occurs during a milkfeeding episode.5 The other studies made the appropriatecorrections to yield more accurate and higher values.Incidentally, we speculated that the difference of approxi-mately 4 mL/kg/d between our own results and those ofCasey et al2 may have been due to the fact that our study,patients were not roomed-in and were fed according toa strict 4-hour schedule. In contrast, the infants studiedby Casey et al2 were roomed-in and fed on demand. Wewere not able to determine whether the infants in thestudy by Santoro et al1 were roomed-in or not, an extremelyimportant variable in a study of breast feeding.

Although Santoro’s stated goals were to report on ‘‘thequantity of milk’’ in relation to ‘‘maternal-obstetric-neonatalfactors,’’ they only reported a multiple regression on weightgain and maternal-obstetric-neonatal factors. Weight gainand milk intake are not necessarily the same. Weight gaindepends on milk intake and many other variables such asmetabolic rate, environmental heat, insensible water losses,urine output, etc. Also, it is unclear from the study howmany variables were chosen as independent variables in theregression equation and why. In our study, milk intakecorrelated strikingly with birth weight both in humanmilk–fed infants and in formula-fed infants.3 This may indi-cate that the larger the baby, in general the more mature it is.We speculate that more mature infants may also have a moremature suck and swallow mechanism.

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Shaul Dollberg, MDDepartment of Neonatology

Tel Aviv Sourasky Medical CenterTel Aviv, Israel

Francis B. Mimouni, MDDepartment of Pediatrics

Shaare Zedek Medical CenterJerusalem, Israel

10.1016/j.jpeds.2010.02.022

References

1. Santoro W, Martinez FE, Ricco RG, Jorge SM. Colostrum ingested

during the first 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 first five 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 first 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 thefirst day of life by exclusively breastfed healthy newborn in-fants. The authors are disappointed with our statement that‘‘there are no reports correlating the quantity of milk ingestedby a healthy and exclusively breastfed infant during the first24 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 pro-gram identifies a large number of articles. But by carefullyreading the studies we support our statement in the Introduc-tion: ‘‘Despite the various studies on milk production at thebeginning of lactation, there are few measurements of milkproduction during the first 24 hours postpartum,’’ and we re-ferred to 3 of these studies.1-3 Dollberg et al4 correlated milkintake with some neonatal factors. Nevertheless, none of thereports correlated the quantity of milk ingested during thefirst 24 hours of life with maternal-obstetric-neonatal factors.

The pioneering study of Casey et al5 and the study of Doll-berg et al4 used a quite different method compared with ourstudy. In the study by Casey et al,5 the weight test was per-formed by the mother and, as described in their Methods sec-tion, ‘‘All mothers were able to commence test weighing by 36hours post partum.’’ The results for milk intake from 0 to 24hours was for 3 infants and ranged from 3 to 32 g/kg. In theintroduction of our study we cited a more recent study byCasey’s group.6

The article by Dollberg et al4 compared the intake ofbreast-fed and bottle-fed infants during the first 2 days of