The Neonatal Bowel Output Study: Indicators of Adequate Breast Milk Intake in Neonates

Linda C. Shrago; Elizabeth Reifsnider; Kathleen Insel


Pediatr Nurs. 2006;32(3):195-201. 

In This Article

Implications for Pediatric Nursing

Study findings suggest that bowel output can be used as a proxy measure for adequate breast milk intake. Parents can easily be taught to monitor the number of daily bowel movements of their infant, and they can be taught to note the day on which their infant's bowel movements become yellow in color. Health professionals can reassure their breastfeeding patients that well-nourished infants have bowel output that is in the range of four or more stools per day by two weeks of age. Health care providers can gather data via telephone about the infant's bowel output. If the infant is not stooling at this frequency by two weeks after delivery, an evaluation by a health care professional that includes weight should be obtained. While it is ideal that all infants be evaluated by a qualified health care provider within days of discharge from the birth setting, as is recommended by the AAP (1997), there have not been studies performed that confirm that this is always done in all locales. When direct assessment is not done within days of hospital discharge, telephone assessment is a beginning point for identifying infants at risk. Indicators that an infant should be seen in person to obtain a naked weight, to determine percentage weight loss, and to be evaluated for possible dehydration include daily bowel output consistently below the "three to four stools per day by 5-7 days of age" as cited by the AAP (p. 1037) and supported by this study's findings of a mean of 4-5 bowel movements per day, or stools not having transitioned to yellow by day seven following birth. A weight check is a low cost, low tech, non-invasive intervention that can be used to identify inadequate intake prior to the onset of serious sequelae.

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