Mary,

Do you have a copy of the "Breastfeeding Answer Book," by any chance?  On
page 266 (Third Revised Edition) is a chart detailing the 1994 AAP
guidelines for treating a full-term baby with rising bili levels.  (I'm not
going to reproduce it here unless someone wants me to, I'd be glad to share
what's on it...though I believe the AAP has since revised their guidelines
again.  I'd love to see more recent information if it is available and
someone here can point me in the direction of it.)

One thing the doctor explained to me in my personal experience (twice) with
*severe* newborn abnormal jaundice (my daughter had a bili of 20.6 at 18
hours old, having not nursed, urinated, or pooped since shortly after birth
-- ABO incompatibility and Coombs+) was the different markers he looked for
in the bloodwork of a jaundiced baby.  One factor he considered was
hemalysis, I believe (someone please correct me if I'm wrong?) -- the rate
at which the baby is still making new blood cells.  This number told him
whether the baby's bili levels were going to drop or continue to rise.  A
baby who is still making lots of blood cells is likely still destroying
many, as well (and it is the byproduct of the destruction of the blood cells
that produces the bilirubin which the baby's liver can't process).  I hope
my explanation of this was clear.

While I could be fairly certain that the baby in the situation you presented
to us was NOT in danger of a rapidly rising bilirubin level, I have seen
babies with borderline bili levels get treated with lights and experience if
not interruption, then difficulty with breastfeeding...but in consideration
of the hemalysis numbers, it might have been safer to err on the side of
caution in those cases.  Just another thing to consider when we see the
bilirubin numbers at face value and want with all our hearts to keep those
babies with their mothers and breastfeeding!

I'd also like to mention that, with both of my babies, we stayed in a level
I hospital (no NICU), the isolette with the bank of lights was wheeled into
a room where I stayed with the baby 24 hours a day.  With my daughter, the
jaundice was severe and I was not "allowed" to breastfeed her (but I
"cheated" and kept trying, which is another story), but with my son, whose
bilirubin was at 14.6 at 30 hours old, breastfeeding, which had started well
after his birth at home, continued successfully despite our hospitalization.

I hope this is helpful,

--Diana in NY

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