I read Katherine's post with interest and think she's on to something.  I don't
know that the bili has to be down to 10-12 to resume direct breastfeeding but
would go more by baby's level of alertness.

It always irritates me when I'm talking by phone to a mother whose baby is
having serial bilirubins done because of high levels and the baby is not being
weighed when in for the bili's.  I run into some kids with bili's over 18 who
are good and alert, nursing up a storm and gaining weight--then you know that
lack of intake is not influencing the bilirubin level.  Then there are others
with higher levels that are sleepier than the dickens that are not feeding well,
not stooling well and not gaining weight.  Those DEFINITELY benefit by stuffing
them full of milk by whatever means is necessary, usually by bottle.  Ever try
to get sufficient amounts of milk into a lethargic jaundiced baby by cup?  Been
there, done that, not reasonable.

I'd never really thought about it, but our temporarily bottle-fed jaundiced
babies go back to the breast without a lot of trouble, also.  Since it's not
done with the alert kids, Katherine's explanation makes sense to
me--anecdotally, of course.  :-)

Becky Krumwiede, RN, IBCLC, hospital-based
Appleton, WI
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