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Date: | Thu, 15 Sep 2005 18:20:34 -0400 |
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Here's the deal:
Jaundice is mainly a problem for breastfed infants who do not feed well.
I've posted before about this.
When starvation occurs, the infant stops stooling (which allows the
bilirubin in the meconium hanging out in the intestines to be
unconjugated by bacteria, which allows the bilirubin to go back into the
bloodstream through the enterohepatic circulation.)
Breast milk does not inhibit the enterohepatic circulation, because
under usual circumstances, bilirubin is helpful to the infant, acting as
a powerful antioxidant. Hydrolyzed casein does. This is the reason
behind the AAPs recommendation that dehydrated breastfed infants with
high risk bilirubin levels receive small amounts of hydrolized formula
while they are being treated for jaundice. Enzymatically hydrolized
casein is the main protein in nutramigen and alimentum, whereas
whey/casein is the main protein in enfamil. Nutramigen and enfamil are
both Mead Johnson products.
This is a helpful study, because it showed that the L-aspartic acid
group had the most elimination of bilirubin. This gives us a better
option than hydrolized casein, so we can avoid exposing babies to
foreign cow proteins, however broken down to inhibit their enterohepatic
reabsorbtion of bilirubin. Now if we just had better breastfeeding
assistance in the hospital, we would have fewer babies who would need
this treatment (just the preterm ones, the ones with genes that reduce
the efficiency of bilirubin conjugation, the ones with hemolytic
disorders....)
Catherine Watson Genna, IBCLC NYC
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