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Subject:
From:
Jim & Winnie Mading <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Sun, 15 Sep 2002 08:56:43 -0500
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Naomi asks:

> Your answers have raised a couple of other questions for me:
> 1. If we assume that breastfeeding is the norm, why is it better
> to get rid of the bilirubin faster? Are there advantages to letting
> the system get rid of bilirubin at its own pace.

Excellent question!  I think a lot of those "wait and see" type docs would say
that speed of reducing the jaundice isn't inportant.  As long as the levels don't
go above whatever level they accept at the top limit, many are willing to let
nature take it's course.  There is more of a concern if the levels are raising,
especially whan that seems to be happening quickly.

> 2. Along those same lines, if it affects 80% of babies,
> then perhaps, as someone else suggested, we should be worried
> about the kids who don't have bilirubin.
>

I first heard this comment at an ILCA conference many years ago (I think it was
the first one at Scottsdale).  It makes a lot of sense, but I don't think anyone
has gone beyond speculation-good subject for some research.

> 3. Are bilirubin levels pretty similar in other parts of the
> world as well? If not, do we know what causes variations?

I know that when we used an earlier "sensor" device, we accepted higher levels
with black or oriental babies.  Don't really know if it was because the sensor was
looking at skin tones or if the levels are higher with different "racial" groups.
If levels are significantly different in other cultures, it would certainly seem
to indicate the contribution management of early breastfeeding makes to bili
levels.

> 4. Is it true that very high bilirubins over a long period can
> cause brain damage?

Kernicterus is a concern with high levels.  The problem is that there are no
universally accepted levles.  The number 20 is cited a lot (Leading to the term
"ventigentiphobia" meaning fear of the number 20 ;>) ).  Some docs will intervene
at anything over 10 while others just keep watching and won't intervene until it's
over 15 or whatever.  Again, rate of increase is certainly a factor.  So is the
source.  Jaundice in the first day or so is much more likely to be due to some
form of blood incompatibility and more likely to need intervention.  The smaller
(earlier) the baby, the quicker it can rise and the sooner intervention usually is
recommended.  I heard one speaker question whether "normal physiologic jaundice"
or true breastmilk jaundice has ever been shown to cause kernicterus, but who
wants to have a baby in their care be the first?

> 5. How common is "breastmilk jaundice?"

Depends entirely on whose statistics you accept.  The problem is that in too many
cases, it's been labeled breastmilk jaundice any time the baby is being breastfed!

> Thanks,
>   Naomi Bar-Yam

Winnie


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