LACTNET Archives

Lactation Information and Discussion

LACTNET@COMMUNITY.LSOFT.COM

Options: Use Forum View

Use Monospaced Font
Show Text Part by Default
Show All Mail Headers

Message: [<< First] [< Prev] [Next >] [Last >>]
Topic: [<< First] [< Prev] [Next >] [Last >>]
Author: [<< First] [< Prev] [Next >] [Last >>]

Print Reply
Subject:
From:
"Jenny Thomas, MD, IBCLC" <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Wed, 24 Jan 2007 10:24:36 -0500
Content-Type:
text/plain
Parts/Attachments:
text/plain (52 lines)
I just wanted to throw my 2 cents in since the new AAP policy on 
hyperbilirubinemia has disrupted my practice of medicine.

I like the discussions taking place over the role of free bilirubin and bound 
bilirubin in the pathogenesis of kernicterus.

R. P. Wennberg, C. E. Ahlfors, V. K. Bhutani, L. H. Johnson, and S. M. Shapiro
Toward Understanding Kernicterus: A Challenge to Improve the Management of 
Jaundiced Newborns
Pediatrics, February 1, 2006; 117(2): 474 - 485

My favorite quote in the article is this "TSB (TSB=total serum bilirubin) is, at 
best, a poor risk indicator for kernicterus and, at worst, an excuse for not 
intervening when intervention is necessary. Laboratory and available clinical 
data are consistent with basic pharmacological principles in demonstrating that 
Bf (free or unbound bilirubin)rather than TSB (analogous to free thyroxine and 
thyroxine) is a critical serum factor involved in brain uptake of bilirubin and 
subsequent neurotoxicity. To improve guidelines for managing 
hyperbilirubinemia and minimize the number of unnecessary and at times 
dangerous therapeutic interventions, there is need for a national strategy to 
obtain prevalence and incidence kernicterus data and to identify Bf and TSB 
levels and independent comorbid factors associated with reversible and 
irreversible bilirubin encephalopathy."  

It essentially says, we should do more research before we make these policy 
statements.  It's interesting that we can create risk zones for a disease that 
we don't know the incidence or prevalence of.  And that we don't quite know 
if bilirubin is the only culprit in kernicterus.

My other questions is based on the risk factors that are in the statement.  
Being Asian is a risk factor, being African -American is associated with lower 
risk.  My kids are both (plus being white and American Indian)....does that 
mean their African American blood protects them from the Asian risk?  I've 
never figured that out.

Back to the trenches.


Jenny Thomas
Milwaukee, WI

             ***********************************************

To temporarily stop your subscription: set lactnet nomail
To start it again: set lactnet mail (or digest)
To unsubscribe: unsubscribe lactnet
All commands go to [log in to unmask]

The LACTNET email list is powered by LISTSERV (R).
There is only one LISTSERV. To learn more, visit:
http://www.lsoft.com/LISTSERV-powered.html

ATOM RSS1 RSS2