The "bilirubin levels" that have been reported in the recent query
about fluctuations in Breastmilk Jaundice have apparently been determined
by a transcutaneous bilimeter.  Only one determination was by blood
chemistry measurement.  Transcutaneous bilimeter measurements are
measurements of the yellowness of the skin and only give an approximation
of the serum bilirubin concentation; transcutaneous bilimeters are only
suitable as a screening technique.  I suspect that repeated serum chemistry
bilirubin concentrations would be more consistent.  Nevertheless,
fluctuations in serum bilirubin levels in Breastmilk Jaundice at 2 to 3
weeks of age are not unusual and this child has a very characteristic
pattern of hyperbilirubinemia for a child with Breastmilk Jaundice -
although it is at the high end of the range seen.  Breastmilk Jaundice is
seen in two-thirds of ALL breastfed infants and is a normal extension of
physiologic jaundice of the newborn.
In any child with an exaggerated level of bilirubin - above 12 or 14 mg/dl,
it advisable to do some screening laboratory studies to rule out hemolysis
and hypothyroidism.  Combined etiologies are always a possibility at these
higher levels.
                                        Larry Gartner
PLEASE NOTE NEW AREA CODE FOR PHONE & FAX

Lawrence M. Gartner, M.D.
Professor of Pediatrics and Obstetrics/Gynecology
The University of Chicago
MC6060
5841 S. Maryland Avenue
Chicago, IL 60637
Phone: (773) 702-0389
FAX: (773) 702-0764
E-Mail: [log in to unmask]