Hi Joyce,

You wrote "We recently had a baby whose bili was 28.  It had no risk
factors such as blood type, bruising, etc.  Weight gain was good. The baby
was put on formula for 48 hours--in addition to triple phototherapy
lights."

Yes kernicterus is pretty scary. The baby in question I believe had a level
of 20. Yes, one does start getting concerned at that level or even lower,
however with light treatment and continued frequent monitoring, the dyad
could keep bf. The case seemed to be amenable to several options, not just
stop the bf for 3 days. Another option could be to bf w/ a formula
supplement via supply line at breast, while undergoing continous light
therapy w/ a bili blanket and other lights when not bf.

The case you describe where the level was 28 in a healthy, gaining baby w/
no risk factors sounds pretty unusual. How old was the baby? Was there
delayed initiation of bf? Was there a significant wt loss in the early days?
Did the baby have kernicterus? My understanding is there have been no cases
of healthy term infants w/ 'breastmilk jaundice' where the baby had
kernicterus. Anyone, correct me if I am wrong please.


Laurie Wheeler, IBCLC, MN, RN
New Orleans Louisiana, s.e. USA

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