In response to Linda Rosetti's question about the effect of
breastfeeding in a newborn with Rh Erythroblastosis, I am happy to report
that there is no contraindication to breastfeeding.  This was investigated
many years ago by Dr. Louis Diamond, the deservedly famous pediatric
hematologist from Boston Childrens Hospital/Harvard and THE authority on Rh
erythroblastosis and exchange transfusions.  He stated at that time, and it
is certainly still true today, that there is no increase in hemolysis as a
result of breastfeeding.  This applies as well to ABO erythroblastosis.
        One might also ask whether breastfeeding will increase bilirubin
levels in these infants with hemolysis because of the late-onset "breastmilk
jaundice".  While breastfeeding prolongs jaundice and increases the
bilirubin level to a modest degree in about two-thirds of all breastfed
infants, this does not happen until after about the fifth day of life, when
bilirubin levels in Rh babies are usually falling.  There probably is some
dencrease in rate of decline of the bilirubin level with breastfeeding after
the fifth day of life; it bears watching, but is not of such magnitude that
breastfeeding should not be initiated.  There may be an occasional Rh baby
that will have to have breastfeeding interrupted for one day because of
bilirubin levels which exceed 20 mg/dl.  Still, the benefits of
breastfeeding far outweigh this small, manageable risk.
                                        Larry Gartner
Lawrence M. Gartner, M.D.
Department of Pediatrics
The University of Chicago
5841 S. Maryland Avenue
Chicago, IL 60637

Phone: (312) 702-0389
FAX: (312) 702-4523
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