----- Original Message -----
From: "Naomi Bar-Yam" <[log in to unmask]>
Sent: Friday, September 13, 2002 3:24 PM
Subject: bilirubin basics
Someone will probably correct me (always welcome critique),but I will give
you the simplest of answers.
"When the baby  is growing inside.it gets it's oxygen from the red blood
cells from the mother by way of the cord and placenta.. When the baby is
born and breathes on her own , the excess red blood cells are to be broken
down and conjugated by the liver and moved along.  Many babies have immature
livers that do not handle the broken down red blood cells ~bilirubin and
therefor it recirculates in the body some settles in the body in the bowel
and under the skin and at very high levels it settles in the brain.(not
good).  Early feeding starts peristalsis and helps to move the bili out of
the bowel , the longer the delay in stooling the more likely the bilirubin
the in bowel reabsorbs by way of the mucous membrane in the bowerl and then
it can be brought back in to the rest of the body.
There are conditions that can move a baby out of the "normal physiological
newborn jaundice" mode.  Some of these are LGA's ,SGAs, bruising , ABO
Incompatibility, prematurity. and other causes.
All the more reason to  nurse the baby  within the first hour of birth . It
helps to get the peristalsis of the infant going with the perfect substance
~colostrum .
Babies with a higher bili count tend to be sleepy ~I have always wondered
why the sleepy ~you would think that Nature would have made the baby more
alert and eager to eat ~ because nursing early and often can make a
difference at least in the ones we see the most "normal physiological
newborn jaundice."
Bilirubin or phototherapy can help .  The photo therarapy has concentrated
"e spectrum."  Daylight has" e spectrum too but with photo therapy for the
infant who needs it ~the phototherapy can concentate the E specturm."  The "
e spectrum" has the effect of helping the bilirubin that is exposed to the
light break down and then can be more readily moved out of the body. "Bili
beds" have made it much easier to keep the baby with the mother if it needs
to be used, Parents can still watch for cues and feed frequently.
Now someone tell me if I am wrong.  I hope not because I have used it many
times.
Beadie Cambardella RN IBCLC
Atlanat GA

> Is there a parent education pamphlet out there on
> bilirubin? What it is? How we identify it? How we
> fix it?
> For that matter, does anyone know of a basic article
> for a non-medical professional like me who has always
> been mystified by bilirubin and can't quite figure out
> how to present it in class.
>
> What I have been taught tells me that bilirubin is
> not uncommon among newborns. If the bilirubin levels
> get high enough it can lead to brain damage which is
> why we treat so conservatively in the US (I have no
> idea what practices are in other countries). Are there
> problems with treating so conservatively (i.e. putting
> under the lights early and often, and of course,
> interrupting bf and the slightest excuse.)
> I also understand that it is rarely necessary to
> stop bf to solve the problem and I tell my chilbirth
> classes that if a doc recommends to stop nursing they
> should get a second opionion from another doc or
> an LC. Can someone explain to me when, if ever, it
> is appropriate to stop nursing for a bit?
>
> Any help or references would be most appreciated.
>
> Thanks,
>   Naomi Bar-Yam
>
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