About 11 yrs ago, I invited Larry Gartner MD,(famous peds & bilirubinologist) out to NJ for 4 days to lecture about jaundice.  I used and abused him!  He did grand rounds in 2 hospitals and 3 dinner lectures, - 2 for just Peds and 1 for nurses, LC LLL etc.
Needless to say, he was mortified by how jaundiced was being handled here.  When Dr Gartner went on rounds and the residents were presenting cases (re-admits for jaundice) he was astounded that they never mentioned how the babies were fed.  
Their lack of and/or misinformation regarding breastfeeding was very poor.  

Dr Gartner also reported that they believe there is a real good reason why babies do re-absorb a certain amount of bilirubin.  Because it acts as an anti-oxident for babies- protecting them from disease and infection early on.  When the NICU uses double lights and drops a preemies bili too quickly - it may put them at more risk for infection.  So a little bit of bilirubin is a good thing and normal. 
I believe as well he remarked - there is colostrum present in the milk for the entire first month in order to facilitate the slow but complete removal of any residual bilirubin.  That's why stooling may be less frequent after 1 month.  

Well, did his visit make a difference?  I wish I could say yes but I can't.

I have babies (all the time) in my practice (3-4 do) who are a bit "tingy", but they are stooling, acting totally appropriate and transferring milk (better after we fix a few things) and the Peds is in a panic! Daily wgt checks, bili levels every 12 hrs - they couldn't assess a breastfeeding mom or baby if their life depended on it.  And these poor babies and moms haven't even got out of the gate yet!  If we are lucky enough and we can see them early - they have a chance but otherwise -That's the "recipe" we are still serving here in NJ -Recipe for failure.

Thanks for the opportunity to rant - you are not alone.  

Maria Parlapiano RN IBCLC
Chatham, NJ

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