I recently had a client whose infant maintained a bili of 19 for two
months. Throughout this time the Ped was insistent that the mother give
formula for a few days to reduce it. Mother chose to not do so and sought a
second opinion. The second doctor, a Family Physician, checked the baby
over well and concluded that he was very healthy and referred the family to
a Neonatologist at Childrens' Hospital. She also contacted Dr. Gartner.

The Neo assured the family that all was well. Baby was developing fine and
had no signs of systemic problems. He said to stop having the bili tested
and just take care of him.

I was quite impressed with his breadth of approach to health care.

It is my understanding that the concern with elevated bilirubin is during
the first 3-4 days of life when the blood-brain barrier is not sealed.
After that time kernicterus, seemingly the major problem, is not a risk. Of
course, if an elevated bili accompanies a sickly, poorly nourished infant,
the underlying problems need to be addressed. It is not a bili problem per
se; the elevated bili is a warning that something else is amiss.

As Dr Cerruti used to say, "Breastfed babies bilis are the norm. We should
be wondering why formula-fed babies' bilis are so low. Some day they will
be putting bili into the formula of newborns."

There are certainly birthing practices that interfere with an infant's
dealing with his bilirubin and the consequent problems need to be resolved.
But in a *healthy, thriving* infant past the first week, treating just to
get the numbers down is not health care.

Pat Gima, IBCLC
Milwaukee, Wisconsin


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