In reference to the case presented by L Stiles the following is my opinion ( a pediatrician in practice 18 months post residency who has seen rec tx levels for hyperbili go from 12 to 17 to 20 depending on the age/situation)
If the baby has poor latch and decreased stoll/void part of the problem is probably dehydration and starvation jaundice. What is the baby's % of birth weight?
I would tx this baby with phototherapy, if necessary for dehydration give suppliment (formula, <not ABM that's Academy of Breastfeeding Medicine>, has more calories than D5W) and breastfed as Larry Gartner,MD calls it "the Chicago Way, early and often"
Two good references are The AAP statement in Pediatrics Oct 94 and March 95 and L. Gartner MD's article in Pediatrics in Review, 1994.
Part of the problem may be this physician's belief as he states. I still see fear of bilirubin in veteran pediatricians.
Is the bay's albumin level know as some feel this changes the significance of the bili level. See work of R Poland,MD.
On the flip side is there any evidence that bilirubin in a term health baby is danagerous?
I'm interested in Dr Jack's reply to this case.
By the way can I get Dr Tom's handout?