A 3-day-old infant who weighs 6 lb (2722 g) is fed formula every 4 hours. Newborns require about 73 mL of fluid per pound (454 g) of body weight each day. In light of this information,approximately how much formula should the infant receive at each feeding?

A) Fundus below the symphysis and not palpable:
The process of involution refers to the shrinking and returning of the uterus to its normal size and position after delivery. By postpartum day 14, the uterus should be largely involuted, with the fundus no longer palpable above the pubic symphysis. This is a normal finding, as the uterus typically shrinks to its pre-pregnancy size over this period. The fundus should be at or below the symphysis pubis and should not be palpable after about two weeks postpartum, indicating that the involution process is proceeding as expected.

B) Moderate, bright red lochia:
While bright red lochia (also known as lochia rubra) is common during the first few days postpartum, by postpartum day 14, lochia should have transitioned to a serosa (pinkish or brownish) or alba (white or yellowish) appearance. Bright red lochia on day 14 would suggest a possible issue, such as retained placental fragments or uterine atony, and would require further evaluation.

C) Breasts warm, firm and tender:
Breast tenderness and firmness can be normal in the early postpartum period, especially as milk comes in. However, by postpartum day 14, if the breasts remain tender and warm, this could indicate mastitis or engorgement that hasn't been resolved. While some tenderness may still occur, it should have decreased by this point. If tenderness persists, further assessment would be needed.

D) Laceration slightly red and puffy:
Postpartum lacerations or episiotomy sites should begin to heal within the first few days, but slight redness and swelling might still be present at two weeks. However, puffiness or continued redness after 14 days may indicate poor healing, infection, or other complications, which requires further evaluation and intervention. Normal healing should show a decrease in redness and swelling by this time.

A) 2 to 3 oz (60 to 90 mL):
To determine the appropriate amount of formula for this infant, first calculate the total fluid requirements for the day. The infant weighs 6 lb (2722 g), and newborns typically need 73 mL of fluid per pound of body weight per day.
6 lb × 73 mL = 438 mL of fluid required daily.
Since the infant is fed every 4 hours, this equates to approximately 6 feedings in a 24-hour period.
438 mL ÷ 6 feedings = 73 mL per feeding.
Converting this to ounces (since 1 oz = 30 mL), the infant would need about 2.5 oz per feeding. Therefore, 2 to 3 oz (60 to 90 mL) per feeding is appropriate to meet the infant's daily fluid needs.

B) 1 to 1.5 oz (30 to 45 mL):
This amount is insufficient for the infant’s daily fluid needs. At 1 to 1.5 oz per feeding, the total intake for the day would be only 180 to 270 mL, which is well below the required 438 mL. This could lead to dehydration and inadequate nourishment.

C) 4 to 5 oz (120 to 150 mL):
This amount is excessive for a 3-day-old infant. Newborns typically consume much smaller amounts at each feeding due to their smaller stomach capacity. Overfeeding could lead to discomfort and potential digestive issues.

D) 3 to 4 oz (90 to 120 mL):
While this range is closer to the required amount, it is still slightly too much for a 3-day-old infant. At this age, the recommended amount is closer to 2.5 oz per feeding, so 3 to 4 oz may be excessive and could contribute to overfeeding, which might be uncomfortable for the infant.