Ann's description of hyperbili protocols seems to be just the tip of the
iceberg. An advocacy group called Parents of Infants and Children with Kernicterus
(PICK) has been active in a number of areas including the following:

Urging parents to demand a bilirubin test with mild jaundice. They define
babies who are most at risk of jaundice as:
1. those with a sibling who had jaundice
2. those who bruise at birth
3. those who are born prematurely
4. those whose skin is yellowish in the first 24 hours of life
5. those who are of East Asian or Mediterranean descent have an added risk of
jaundice because jaundice is harder to see with darker skin tones
6. those babies who don't eat much in the first few days of life.
Breastfeeding mothers may need to temporarily supplement with formula if the newborn is
sucking poorly.

Parents are also urged to demand phototherapy if bili levels are 15 or
higher. The CDC is being lobbied to recommend that all babies be tested for
hyperbili and will probably issue a statement after the AAP issues its own this fall.
And because there is money to be made in all of this, a new drug,
Stannsoporfin, is under testing to be given to high-risk newborns. One injection halts the
body's production of bilirubin for about a week. The NIH considers this drug
the only hope on the horizon of completely eliminating kernicterus.

Once again, breastfeeding is front and center as something that is risky. If
we think formula supplementation is out of control now, wait until
Stannsoporfin hits the market and all of the yellow pigment hits the fan. Between the
CDC's possible recommendations and the AAP's statement we will need to be ready
for another blow to breastfeeding.

Marsha Walker, RN, IBCLC
Weston, MA

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