Beth,
I recommend that you obtain or borrow a copy of Breastfeeding; A guide for
the medical profession [Lawrence] or Breastfeeding and Human Lactation
[Riordon & Auerbach] - these resources will give you a better understanding
of jaundice as it is related to breastfeeding.

First I'd like to point out that that the physiologic jaundice that occurs
in some full term breastfed newborns and peaks at about 3-4 days postpartum
is breastFEEDing jaundice and is related to the amount of breastmilk going
into the child. This is indirectly related to  1. opportunity to be at the
breast [hospital policy, cultural expectations, teaching of parents]   2.
ability to suckle effectively [meds in labor, nipple confusion, engorgement,
structural issues like cleft palate and tongue-tie]  3. milk supply  [prior
breast surgery, breast changes in pregnancy, medications - especially birth
control]

BreastMILK jaundice peaks at around 2 weeks and is related to enzymes, etc
in breastmilk and in the baby's intestines.

Neither of these are cause to stop breastfeeding. If it is breastFEEDing
jaundice, you correct the problem [or ideally avoid the problems in the
first place].  The bilirubin level can be brought down by phototherapy
between feeds if needed.

BreastMILK jaundice can be treated the same way. This tends to be a slow
steady rise so seldom needs any treatment.

A good article is JAUNDICE IN THE BREASTFED INFANT  by Gartner & Lee from
Clinics in Perinatology Volume 26, number 2, June 1999

A word of caution about medical literature involving jaundice and
breastfeeding - many of the articles are written by people who know a lot
about jaundice but not much about breastfeeding [Gartner is an exception to
this].

Gail Hertz, MD, IBCLC
Hershey, PA



Subject: Breast-Milk Jaundice


> >
> >Hello, I am a nursing student at the University of North Dakota.  I was
> >recently reading through the Lactnet archives and came upon breast-milk
> >jaundice.  In reading about breast-fed jaundice I came to the
> >understanding from one article that the etiology of this type of jaundice
> >is still unknown. (Brown, Arnold, Allison, Klein, Jacobsen, 1993).  I
also
> >read that with severe, hyperbilirubinemia associated with breastfeeding
> >that bilirubin encephalopathy can occur in healthy infants. (Tan,
> >1998).  Encephalopathy is very dangerous and should not be taken lightly,
> >but in one study some neonatologists and physicians would allow
> >breastfeeding to continue without interruption even at levels of 30
> >mg/dl. (Gartner, Herrarrias, & Sebring, 1998).  My question is in your
> >practice when would you suggest stopping breastfeeding and if so at what
> >bilirubin levels?
> >
> >Thank you for your time,
> >
> >Beth Lund
> >Nursing Student
> >University of North Dakota
> >
> >       Brown, L., Arnold, L., Allison, D., Klein, M., Jacobsen,
> >B. (1993). Incidence and pattern of jaundice in healthy breast-fed
infants
> >during the first month of life. Nursing Research, 42(2), 106-109.
> >
> >       Gartner, L., Herrarrias, C., Sebring, R. (1998). Practice patterns
in
> >neonatal hyperbilirubinemia. Pediatrics, 101 (1), 25-36.
> >
> >       Tan, K. L. (1998). Decreased response to phototherapy for neonatal
> >jaundice in breast-fed infants. Archives of Pediatric and Adolescent
> >Medicine, 152 (1), 1187-1196.
> >
> >
> >
> >
> >
> >
> >
> >
>
> Kathleen B. Bruce, BSN, IBCLC co-owner Lactnet, Indep. Consultant
> Williston, Vermont
> mailto:[log in to unmask]
> LACTNET Archives http://peach.ease.lsoft.com/archives/lactnet.html
>

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