There is believed to be some protective benefits of elevated bilirubin as an
antioxidant that actual is protective of the newborn's brain.  <A HREF="http://www.drjaygordon.com/pediatricks/bilirubin.htm">Bilirubin as
an Antioxidant</A>

Yet if the level goes in the high 20s or above, kernicterus may occur.
Kernicterus is an ecephalopathy caused by deposition of unconjugated
bilirubin in brain cells and may result in brain damage or death.  In most
cases, good breastfeedings with plenty of stooling will take care of reducing
the bilirubin.  However, if bilirubin is 16 or higher the baby may not
breastfeeding effectively and may be sleepier or even lethargic (this depends
on the individual baby, gestational age, stress during birth, bruising during
birth, wellness of baby and many factors).  If baby is too sleepy to
breastfeed effectively then the milk should be pump and baby finger fed or
bottlefed EBM till bilirubin drops enough for baby to feed effectively.  <A HREF="http://www.neonatology.org/syllabus/bili.klein.html">
Neonatology on the Web: Hyperbilirubinemia (Klein)</A>

Larry Gartner, MD does excellent talks on hyperbilirubinemia.  His tapes can
be ordered from LLLI.  With ineffective feeding at breast and jaundice. I
like to agressively feed the baby by pumping and finger feeding till baby
becomes more wakeful and can breastfeed effectively.  Usually 1-2 days.

Warm regards,
Pat Lindsey, IBCLC - Lactation Services  www.PatLC.com
Pediatrics Plus' Lactation Consultant   www.pedsplus.com

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