Jaundice often comes earlier and stronger if baby is born before 37
completed weeks of pregnancy too.  It may be due to an extra high hematocrit
in the baby, ABO or Rh incompatibility, sepsis or trauma, as previously
mentioned.  It may also be that the measurements have been inaccurate, and
the baby isn't as jaundiced as feared. The challenge is establishing
breastfeeding when the baby is being treated, and such early onset jaundice
is treated more aggressively than a physiologic jaundice that just happens
to exceed the limit for phototherapy. This means baby may be separated from
mother, if phototherapy is provided by lamp over a scantily clad baby, and
it may have its time outside the lights severely restricted due to hospital
procedures for phototherapy.  Need to emphasize for mother that this will
pass, and get her going on expressing colostrum, and then milk, so when baby
is able to come to breast and is fit enough to feed effectively, she will
have something to offer.
Rachel Myr
Kristiansand, Norway

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