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Lactation Information and Discussion <[log in to unmask]>
Date:
Tue, 29 Sep 1998 05:32:58 -0400
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I don't know if I agree with "breastmilk jaundice" giving bilirubins as high
as 20-30 (340-510 micromoles/l) for several months.  That must be distinctly
rare and I would really worry about such levels.  Such a baby would not be
yellow, he would be orange.

I disagree though with the idea that the babies should be taken off the
breast for 48 hours to "prove the diagnosis".  Any physician worth his salt
can distinguish between the baby with "breastmilk jaundice" and "something
else".  In the first place a baby with biliary atresia, by one month of age,
has a big liver and spleen.  Secondly, the simple question to the mother
"what colour is the baby's urine?" will suffice to rule out liver disease.
The urine of the baby with liver disease is brownish, and no well gaining
exclusively breastfeeding *healthy* baby has brownish urine--it is as clear
as water.  In our clinic we will routinely bag a baby on arrival in case
urine is needed (they are rarely needed, however).  A dipstick is available
that tests for bilirubin in the urine, or you can just look at the urine
against the light.  Urinary tract infection is supposed to be a cause of
prolonged and elevated bilirubin, but I have seen only one in 14 years of
doing a breastfeeding clinic which really convinced me that the bilirubin
was elevated because of a urinary tract infection, and even then, the baby
was gaining poorly, so that the elevated bilirubin could have been due to
poor intake.  Congenital hypothyroidism should be ruled out, as it usually
is by the neonatal screen, but you won't find too many, since it occurs in
only 1:6000 live births.

There are some really rare enzyme deficiencies of the liver which cause
elevated bilirubins, but it is madness to test for these in a healthy happy
growing...okay, yellow baby.

Jaundice is normal in exclusively breastfed well gaining babies, for weeks
and even months, though it is usually only noticeable if you look carefully.
What is not normal is the absence of jaundice in artificially fed babies
(formula feeding anicteris).  Physicians should rather encourage women with
babies with *hypobiliribinemia* due to artificial feeding to take the babies
of the formula for a couple of days and put them on the breast so that the
bilirubin rises into the normal range.

Jack Newman, MD, FRCPC
Toronto, Canada

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