What is disturbing in the history as given is that the bili went into the
teens within the first day of life.  This is definitely abnormal.
Physiologic jaundice just doesn't behave this way.  The baby needs
investigations done to try to pinpoint the cause of the jaundice.  If the
baby is breastfeeding well and gaining weight, hypocaloric intake can be
instantly ruled out.  The baby needs looked at for autoimmune-mediated
jaundice (ABO incompatibility or other blood group interaction), whether
there is a significant direct bilirubin component (looking for liver
disease), looking at the hemoglobin (to check for hemolysis), possible
consideration for metabolic disease (Dubin-Johnson Syndrome for example),
etc., etc., etc.
Have any of these investigations been considered or done?
Linda Shaw MD FAAP

             ***********************************************
The LACTNET mailing list is powered by L-Soft's renowned
LISTSERV(R) list management software together with L-Soft's LSMTP(TM)
mailer for lightning fast mail delivery. For more information, go to:
http://www.lsoft.com/LISTSERV-powered.html