All of the following is from reference 1 below:
There should be 8 to 12 feedings per day.
There should be no more than 4 hours between feedings. It there is then the baby should be seen right away to make sure that he or she is not sick (infected) or dehydrated.
A baby that is not dehydrated has moist mucous membranes, strong pulses, good capillary refill, normal alertness, easy to awaken, normal pulse rate and a normal respiratory rate.
Urine output
Day 1 (first 24 hours)–minimum of one urine output
Day 2 (second 24 hours)–two or three urine outputs
Day 3 (third 24 hours)–four to six urine outputs
Day 5 (fifth 24 hours)– six to eight urine outs and thereafter
Stool Output
Day 1 (first 24 hours)–one stool
Day 2 (second 24 hours)–one stool
Day 3 (third 24 hours)–two stools
Day 4 (fourth 24 hours)–at least three stools per day through the first month
Infrequent stools during the first 4 weeks of life are abnormal because it means the baby is not getting enough milk. The reason the newborn with less than normal stool number needs to be checked is because the baby can be dehydrated. So all newborns with infrequent stools need to be checked in the office.
Sometimes inadequate breast milk production can cause severe newborn dehydration. To make sure this doesn’t happen, supplement breast feeding with ½ oz to 1 oz of formula or expressed breast milk following each attempt at breastfeeding when: (1)
There is inadequate urine output—Day 2 and no urine output for more than 12 hours; Days 3 and 4 and no urine output for more than 8 hours.
There is inadequate stool production—Days 2 and 3 and no stool for more than twenty four hours; Day 4 and less than 3 stools per 24 hours.
The Newborn is 5 days or older and has less than 3 stools per day or less than 6 urines per day
There is weight loss of greater than 7% accompanied by delayed onset of adequate milk volume after Day 3
There is weight loss of less than 7% but there is delayed onset of adequate milk volume and the infant is inconsolable
There is inadequate milk transfer despite adequate milk volume.
There is significant physiologic jaundice. [I recommend formula supplentation rather than expressed breast milk in this case]
There is breast milk jaundice. [I recommend formula supplentation rather than expressed breast milk in this case]
And all these at risk newborns need to be seen by the doctor within 24 hours.
(1) Breastfeeding Questions in Pediatric Telephone Advice. 2011, Barton D Schmitt MD.
