The ingredient in breastmilk that changes bilirubin from the kind that can be pooped out (direct or conjugated bilirubin) to the kind that is stuck in the body (indirect or unconjugated bilirubin) is called beta glucuronidase.  
   
  Of course the very PRESENCE of beta glucuronidase says that there is some reason bilirubin should hang around for physiologic benefits during adaptation to extrauterine life (for normal healthy babies).  Just like many other things, too much of a good thing can hurt when the body is not healthy, but that doesn't mean that the exceptions to the minority should eliminate the benefits to the majority.  
   
    Catherine Watson Genna mentioned the hydrolyzed formula decreasing re-uptake in the gut.  I am curious if it is actually decreasing re-uptake in the intestine as opposed to blocking de-conjugation of direct bili?  Could addition of the formula simply decrease the concentration of beta glucuronidase that would be present from full feeds of breastmilk?  
   
  In regard to this whole issue, it seems to me that we are ignoring the proverbial elephant.  Instead of quibbling about formula vs breastmilk and higher vs lower bili, which is a losing argument in light of the levels set in the AAP policy statement, the approach should be to use the existing literature to open the discussion about beneficial levels of bilirubin. Breastfed babies have an advantage here people!
   
  The AAP policy so screams bought and paid for.  It was a brilliant investment such a small amount of research on only one specific issue and a quick paintjob to set jaundice as all pathologic.   Such an ingenious way to start a baby on the road to pharmaceutical use. Only question was whether it was the phototherapy or formula industry--or both? 
   
  I'll move out of the land of cynicism now.
   
  Karen Seroussi, IBCLC, MS-2 

   
   

 
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