I just wanted to throw my 2 cents in since the new AAP policy on hyperbilirubinemia has disrupted my practice of medicine. I like the discussions taking place over the role of free bilirubin and bound bilirubin in the pathogenesis of kernicterus. R. P. Wennberg, C. E. Ahlfors, V. K. Bhutani, L. H. Johnson, and S. M. Shapiro Toward Understanding Kernicterus: A Challenge to Improve the Management of Jaundiced Newborns Pediatrics, February 1, 2006; 117(2): 474 - 485 My favorite quote in the article is this "TSB (TSB=total serum bilirubin) is, at best, a poor risk indicator for kernicterus and, at worst, an excuse for not intervening when intervention is necessary. Laboratory and available clinical data are consistent with basic pharmacological principles in demonstrating that Bf (free or unbound bilirubin)rather than TSB (analogous to free thyroxine and thyroxine) is a critical serum factor involved in brain uptake of bilirubin and subsequent neurotoxicity. To improve guidelines for managing hyperbilirubinemia and minimize the number of unnecessary and at times dangerous therapeutic interventions, there is need for a national strategy to obtain prevalence and incidence kernicterus data and to identify Bf and TSB levels and independent comorbid factors associated with reversible and irreversible bilirubin encephalopathy." It essentially says, we should do more research before we make these policy statements. It's interesting that we can create risk zones for a disease that we don't know the incidence or prevalence of. And that we don't quite know if bilirubin is the only culprit in kernicterus. My other questions is based on the risk factors that are in the statement. Being Asian is a risk factor, being African -American is associated with lower risk. My kids are both (plus being white and American Indian)....does that mean their African American blood protects them from the Asian risk? I've never figured that out. Back to the trenches. Jenny Thomas Milwaukee, WI *********************************************** To temporarily stop your subscription: set lactnet nomail To start it again: set lactnet mail (or digest) To unsubscribe: unsubscribe lactnet All commands go to [log in to unmask] The LACTNET email list is powered by LISTSERV (R). There is only one LISTSERV. To learn more, visit: http://www.lsoft.com/LISTSERV-powered.html