I'm not even done reading the article yet but had to stop and post this -- I kept thinking, this belongs on LactNet! This study supports the argument of Dr. Jack and others that hyperbilirubinemia is mostly a result of inadequate feeding and has little to do with breastfeeding per se. In fact these researchers found that breastfeeding is negatively correlated with hyperbilirubinemia. Interestingly, the use of vacuum extraction during delivery was positively correlated with hyperbilirubinemia, while cesarean section was negatively correlated. Here is an excerpt from the Discussion section: "The controversy in literature regarding hyperbilirubinemia of unknown origin is whether breastfeeding increases the incidence of jaundice in the first days of life. Numerous authors1-4,10,12 have reported a striking association between breastfeeding and significant hyperbilirubinemia, but other reports5,11 have not substantiated this observation. Our data show that a TSB [total serum bilirubin] >12.9 mg/dL (221 µmol/L) is significantly associated with supplementary feeding and weight loss after birth, whereas breastfeeding is not correlated with hyperbilirubinemia in the first days of life: breastfed infants represent only 38.4% of infants with a bilirubin level >12.9 mg/dL (221 µmol/L). One possible explanation is that in our hospital, full-term newborn infants start breastfeeding in the delivery room, they are in a rooming-in setting, and are breastfed on demand. Infants receive supplementary feeding only when adequate breastfeeding has failed. In fact, breastfed infants, compared with newborns given supplementary feeding, had lower weight loss after birth than did the overall studied population. Moreover, jaundice was first evident in 42% of infants on the second day and in 55% on the third day when the percentage of infants with a maximum weight loss was 52% and 45%, respectively. Multiple regression logistic analysis shows a statistically positive correlation between TSB >12.9 mg/dL (221 µmol/L) and weight loss percentage after birth. These data confirm that the development of neonatal jaundice is not associated with breastfeeding per se but rather with increased weight loss after birth subsequent to fasting, suggesting the important role of caloric intake in the regulation of serum bilirubin. In fact, Osborn et al2 as well as Maisels et al4 found that jaundiced infants did lose more weight than control infants. A relationship between fasting and hyperbilirubinemia has been previously reported both in adults and animals.13,14" The full text is at http://www.pediatrics.org/cgi/content/full/107/3/e41 or PEDIATRICS Vol. 107 No. 3 March 2001, p. e41. Margaret LLLL in Longmont, Colorado *********************************************** The LACTNET mailing list is powered by L-Soft's renowned LISTSERV(R) list management software together with L-Soft's LSMTP(TM) mailer for lightning fast mail delivery. For more information, go to: http://www.lsoft.com/LISTSERV-powered.html