> Brenda Phipps wrote:
> <<That "Neonatology on the Web" website which you sent is very good, and I
> plan to post it, but I have a question: In paragraph 10, it states-
> "breast-milk jaundice occurs in almost two-thirds of all breastfed
> infants". Is that true? Seems high to me. >>
And later Chris wrote:
> The article on jaundice and bf by Gartner and Herschel in Pediatric
Clinics
> of North America (48:2, 389-99) says, "In contrast to artificially fed
> infants, at least two thirds of all breastfed infants have serum bilirubin
> concentrations that exceed the adult normal level of 1.5 mg/dL ...during
the
> third week of life..." I figure that Larry Gartner knows if anybody
knows!
Lactnetters,
This confuses me. I'm not doubting the information but I need some help
understanding this. Breastmilk is the physiologic & biologic norm and a
full two thirds of breastfed infants have "high" serum bilirubin levels
during week three. That makes me think there is some evolutionarily
adaptive reason for the elevation. If two thirds of a population falls in
the "high" range doesn't that make it the norm? Before formula and testing
for these sorts of things were two thirds of all babies developing
complications from jaundice? Is anything over the adult normal level
considered high? Which brings up another question for me. I've
always heard the levels given in whole numbers, with some becoming concerned
at about 15 but more recent guidelines suggesting 27 or 28 a more
appropriate range to become concerned.
Dawn in Austin<<<
----------
I don't know how to access the actual study, but I remembered reading about
a study done at Johns Hopkins, and this is what I found:
"NEONATAL JAUNDICE
Frank A. Oski, M.D., Given Professor and director of the Department of
Pediatrics at Johns Hopkins University School of Medicine in Baltimore,
recently called into question the practice of pediatricians to treat
hyperbilirubinemia in young, otherwise healthy infants.
He reviewed the medical literature and noticed that the conclusion that
bilirubin levels in excess of 20 mg/dL were toxic was based on a study of
infants, most of whom had hemolytic disease from Rh incompatibility. Studies
done in the next decade showed that there was no bilirubin level at which
otherwise healthy infants were at risk of brain injury.
An exhaustive study in 1990 found no evidence that high bilirubin levels in
otherwise healthy children produced brain injury, neurologic damage, or
hearing loss. They found no association between high bilirubin levels and
reduced I.Q. levels.
Breast-fed infants typically have higher bilirubin levels than do bottle-fed
infants. Other factors known to increase the risk of hyperbilirubinemia
include delayed feeding of the infant, diabetic mothers, bruising, labor
induction using oxytocin, and polycythemia (unusually large numbers of red
cells in the blood).
Dr. Oski suggests that treatment for neonatal jaundice be delayed at least
until the bilirubin reaches 25 mg/dL. He points out that this will save
millions of dollars in health care expense, and save many parents great
anxiety. (Contemporary Pediatrics April 1992, p. 148-154) "
http://www.tagnet.org/abstracts/v12n3.htm
Also, I thought that "breast-milk jaundice" was very different from
physiologic jaundice. In everything I have read about this (which is
probably undoubtedly less than some of you, so correct me, if I'm wrong), I
had been given the impression that normal "physiologic" jaundice (which I
think Gartner and Herschel are referring to) has numbers that are quite
high. However, "breast-milk (or breastmilk) jaundice" comes on later, and
is something that is specific to breastfed babies.
Dr. Newman has written an article about this:
http://babiestoday.com/breastfeeding/drjack/jaundice.htm
-Saara Harvie
Breastfeeding Advocate, avid reader, mom to 2 breastfed/ feeding kids,
member of the Flin Flon Baby Friendly Initiative
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