Hi Carrie, Don't confront the doctor just yet. Do some google searches for neonatal hyperbilirubinemia and various combinations of words like formula + breastmilk. If you have access to Peds journals, you should be able to find many articles and you should read the Academy of Breastfeeding Medicine protocol for jaundice, which can be found on a web search. At the end of my post I've listed one that I found but couldn't access + don't see a publication date. Also if you haven't already, you will find it very informative to study the algorithms from the AAP on when to start phototherapy for term, preterm, high risk, low risk, intermediate risk babies. This will give you an idea of what situations are more worrisome than others. There is something about formula which appears to get bilirubin conjugated faster, or there is something in breastmilk which makes bili conjugate slower (normally, really). All of this is not really a problem for healthy term babies that are bf well, and have bili levels below about 15 in the first week. The problem comes in when healthy term babies are not eating well or not eating often enough, or not getting milk due to low supply or when preterm babies are affected and who are more vulnerable to bilirubin encephalopathy at lower bili levels or when pathology is present such as ABO incompatibility or sepsis, for example. Now, this is a complicated issue (which I have posted on before, btw, and those should be in the archives). The management of which often depends on the doctors comfort level with bf, comfort level with various levels of bilirubin, comfort level with parent's compliance and followup ability etc. If one is following a several days old healthy term infant and mother who needed some early guidance on bf management, and all is well, and the bili level is under 15, one can just fix/support the bf and continue on. If one is following a preterm baby whose bili levels are not excessively high, but who is not feeding very well, and if mother has adequate milk production, then one can supplement with ebm. The problem comes in when the health care provider feels the level is too high (often rightly so), or that the breastmilk itself will make the bili go up, and it's already pretty high, or the baby is only a day or two old, and likely his bili will go up the next day or two regardless...... My suggestion is to observe and ask exactly what the doctor thinks is going on, and rationale for the management chosen, and then possibly throw your 2 cents in where applicable. Like "Dr. Jones, I've been working with Mrs. Smith, and she was having trouble getting the baby positioned and latched. We fixed that and the baby is now bf very well. She has a good milk supply. Since the baby is full term with no risk factors, how would you feel about having her supplement with her own milk for the next 24 hrs? [stop here or maybe go on to say] He's 4 days old and still below the level he would need phototherapy and mother seems to understand really well about feeding him often and making sure he's pooping." (probably not necessary even to supplement, but you get the idea of working with the doc). Well sorry to go on so long about this, it is one of my areas of interest and luckily at this employment I am blessed to have doctors who manage this quite well with low intervention. This has not been the case at other places I have worked, where healthy term babies with levels of 10 were removed from their mothers and given phototherapy. AARGH! Laurie Wheeler, RN, MN, IBCLC Mississippi USA Breastfeeding, Diet, and Neonatal Hyperbilirubinemia *Glenn R. Gourley, MD **OBJECTIVES* *After completing this article, readers should be able to:* Compare and contrast the incidence of hyperbilirubinemia between breastfed and formula-fed infants throughout the neonatal period and its relationship to early hospital discharge. Describe possible reasons for the occurrence of hyperbilirubinemia in breastfed infants. Compare and contrast the incidence of hyperbilirubinemia related to different infant formulas. Among the many factors related to neonatal hyperbilirubinemia is the composition of an affected infant's diet. In 1879, Frerichs suggested that "bad nursing" could "exercise a powerful influence" on neonatal hyperbilirubinemia. Much has been learned since this suggestion was made. * **EPIDEMIOLOGY* Many investigations have documented that the consumption of human milk is related to neonatal hyperbilirubinemia, including one review of 12 studies involving more than 8,000 infants in the first week of life and controlled for factors such as hemolysis to enable comparison of dietary effects alone. Moderate hyperbilirubinemia (total serum bilirubin [TSB], 205 mcmol/L [12 mg/dL]) was present in 12.9% of the breastfed infants and 4% of the formula-fed infants (*P*<0.00001). Severe hyperbilirubinemia (TSB, 256 mcmol/L [15 mg/dL]) was present in 2% of the breastfed infants and 0.3% of the formula-fed infants (*P*<0.00001). Breastfed infants have higher serum bilirubin levels on each of the first 5 days of life, and this hyperbilirubinemia can persist for weeks to months. The association between feedings of human milk and neonatal hyperbilirubinemia has been reported in preterm infants fed banked human milk or mixtures of human milk and formula and among various races. More recent studies of otherwise healthy newborns have used noninvasive transcutaneous devices to assess hyperbilirubinemia daily (Figs. 1[image: Go] and 2[image: Go] ). These studies agree with earlier conclusions that otherwise healthy infants exclusively fed human milk will have higher levels of hyperbilirubinemia than infants who consume formula. The difference begins to become significant *. . . [Full Text of this Article<http://neoreviews.aappublications.org/cgi/content/full/neoreviews;1/2/e25> ]* *********************************************** Archives: http://community.lsoft.com/archives/LACTNET.html To reach list owners: [log in to unmask] Mail all list management commands to: [log in to unmask] COMMANDS: 1. 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