Sharon,

This is going into my "keeper" files. You are right! It is very
complicated, and having a review handy will help. Thank you for putting
it in terms I can follow without having to re-read each sentence numerous
times!

<Feeding formula will get the meconium moving.  So
 will feeding expressed or donated breastmilk. . . . . added concern if
stools are not moving regularly
 through the system.  In addition, there seems to be a substance or
substances in the breastmilk which also causes the deconjugation of
bilirubin in the gut and/or hinders the initial conjugation of bilirubin
 in the liver. . . . . but there are other substances besides glucaronic
acid (glucose being one) that can conjugate with bilirubin>

This answers an old question for me: "How come we never heard much about
jaundice (and therefore never noticed much) in newborns 4-5+ decades ago?
Granted, there were some "calm, sleepy babies" that were welcome in the
nursery because they kept mostly quiet.

But the practice of keeping babies NPO for 12 hours then giving them as
much 5% glucose water as they could be "encouraged" to take, every 4
hours for 3 feedings, before either breastfeeding or bottle feeding
started, caused a very obvious laxative effect.

Perhaps it also conjugated some of the bilirubin. Breastfed babies who
were still unsatisfied after their limited 5 or 7or 10 minutes at one
breast q 4 h. were given p.c.'s of 5% GW.

But I think it also may have helped dehydrate the babies during the whole
process, as well as causing rebound hypoglycemia, and this may be why it
fell out of favor.

I wonder what would happen to bilirubin levels if some research project
were to include Dr. Newman's suggestion for using glucose water to expand
the volume and of the first colostrum expressed and thin it out so it
wouldn't stick to the cup or dropper?

Are there some neonatologists who could comment on this as a possible
alternative for parents to request to avoid formula if bili levels are of
concern?

Just wondering . . . .

Jean
****************
K. Jean Cotterman RNC, IBCLC
Dayton, Ohio USA

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