Kathy,
The pediatrician is partially right, but the conclusion of danger is
probably wrong-- while there seems to be a factor in some mother's milk that
slows down the processing of bilirubin, the resultant prolonged exposure in
the infant is not necessarily bad. In fact, recent research is identifying
bilirubin as an antioxidant, and using the premise that breastfeeding is a
normal process and that the breastfed baby should be the reference point for
normal and not the formula-fed baby, it has been suggested that the
prolonged elevated levels of bilirubin in otherwise healthy breastfed babies
may actually be protective to the newborn, rather than dangerous.

Larry Gartner MD has written extensively on jaundice; the latest article I
have from him is in Clinics in Perinatology June 99 (p431-445). Here's the
quote that sums up the answer, under the section "Breast milk jaundice."

"In others, jaundice or hyperbilirubinemia may be detectable well into the
second and even third months of life. Complete or partial interruption of
nursing and the feeding of artificial milk hasten the decline of serum
bilirubin concentrations, but this is not advised unless the serum bilirubin
concentration is in excess of 20mg/dL in healthy full-term newborns or there
is evidence of significant starvation or dehydration. Even without reduction
or cessation of breastfeeding, serum bilirubin concentrations eventually
decline to normal."

My only two moderating concerns for the baby in question include the
ramifications of being a premie (less mature systems), and the slightly low
weight gain at 4/oz week. Perhaps a little more breastmilk might help the
whole picture?

Lisa Marasco, IBCLC

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