>please explain this "Direct Bili" vs "Indirect Bili"<
Hi Janet and Netters,
After the RBC (red blood cell) is broken down in the spleen, the "heme"
from the hemoglobin is further acted on by enzymes where then you have
fat-soluble bilirubin also called unconjugated and indirect.  When testing
the indirect bilirubin, that is the bilirubin you are testing.  It is the
most dangerous in that it is fat-soluble and gets absorbed into the fatty
tissues, the skin and the big concern, the brain.  From there the indirect
bilirubin travels through the liver where conjugation occurs and  the
results are water-soluble bilirubin also called conjugated and direct
bilirubin.  From there, the conjugated bilirubin travels the biliary
system, into the duodenum where other changes occur and then the bilirubin
can be excreted on out the stool (or it gets reabsorbed if infant not feed
well, etc.).  If the direct bilirubin is high, it may  be an indication of
biliary problems (biliary atresia) or a liver disease.  Usually an I
(indirect), D (direct),and T (total) bilirubin test is ordered by the
physician.  The total bilirubin is the number, ie-13mg/dl or 19mg/dl, you
usually hear about.   Not to confuse you more, but it is a very fascinating
process.  Get the baby breastfeeding well from day one without supplements
and the risk of hyperbilirubinemia is greatly decreased, the most common
cause of physiologic jaundice.  Just my two cents.  
Pat Bull, RN, IBCLC
The Breastfeeding Connection/Medela, Inc
Naperville, Il