i think there are several factors at play re slower lowering of bilirubin in
breastfed babies. in the hospital where i work now the breast babies are fed
4 hourly with water in between. (argh) so i think the milk intake is very
low. compared to the formula fed infant who is probably taking in more per
feeding. it would be nice to have the baby room in and bf on cue and have
the bili blanket used instead of mother/baby separation w/ baby in nursery.
also breast babies often don't go to breast for maybe 8 or 12 hrs (common)
and get a glucose water feed or two first. (another argh). i very often see
the jaundice appearing the first day, even in the absence of pathology. i
attribute it to delayed bf and widely spaced feeds, contributed to by
routine mother/baby separation. oh to be in a baby friendly place!
also you have the factor of formula babies having 'abnormally lower' levels
of bili ala dr. newman's take on it, as i understand. bf is the norm. it is
normal for bili levels to be elevated to some extent and for jaundice to be
present even for months.

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


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