I believe there is an enzyme in the intestines which converts (conjugates) fat soluble (unconjugated) bilirubin to water soluble (conjugated) bilirubin, but this enzyme is found in adults. So, it is missing in an infant. Fat soluble bilis are flushed out in stool, and this is when colostrums is especially helpful, as it has a laxative effect to move the meconium out. The longer the meconium stays in the intestines, the more the bilirubins are reabsorbed, and the higher the bili levels go. Lack of breastfeeding causes lack of stooling, which causes increase in bili levels for babies. What formula does, especially DHA-ARA, is force the intestines to clear themselves out, sometimes at levels of stooling which is ridiculously high. It's not an enzyme, it's diarrhea, that clears out the bowels which decreases the bili levels. If this OB practice has a history of such difficult births (hemotomas, vacuum extractions, cesarean sections) it is no wonder they feel they have to flush out bilis. Injured babies, especially when one can visually witness the bruising, have a hard time adjusting to life outside the womb. Bruising increases the bili levels, because the body has to work to rid itself of the blood which has leaked into places it doesn't belong. Sounds like you're on the right track Molly. These mothers trust you, and you have good information. Best wishes, Sam Doak Marietta OH << Dear All, I had such a frustrating time last week and would like some assistance. I had 3 moms, all in one week, call me after discharge confused with the orders they were recieving from their peds office. I had assisted all 3 moms in the hospital and they were all doing well despite their birth experiences ( 2 had hematomas from vaccum and 3rd C/S). All 3 were jaundice at F/U appointment at peds. One had already gained 4 oz, 1 had gained 1oz and the last had maintained. They were told to breastfeed every 2 hours and to give 1 oz of formula to flush out the bili. The highest # of the 3 was 15 on day 4. All babies were feeding well, frequent stools. They had all come to my prenatal class and were calling me for advice. I spend my day doing damage control!!!!! They were all told there is an enzyme in the breastmilk that will keep the higher levels of jaundice. One of the docs in this practice says they need formula to create biochemical activity in the liver to rid of the bili??? Why is it that they think it is ok to compromise the baby's gut with ABM when the breastfeeding is going well????? I go to lecture frequently and when I heard Dr. Newman in April he said that babies are not jaundice because of breastfeeding because of lack of breastfeeding. I am going to approach this Dr. to discuss this since this is her protocol for jaundice and breastfeeding. I just needed to ask all of you for help as I want to have it clear in my head what the correct info it. ( Which I know but need to hear it from the wise ones) Is there really an enzyme? I don't remember hearing that. I am going to give her the ABM protocol for supplementation and was wondering if there was anything else anyone would recommend. Thank you in advance for any words of wisdom. Praying that this week will be better than last. NOT!! Molly Shakar RN, IBCLC >> *********************************************** 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. To temporarily stop your subscription write in the body of an email: set lactnet nomail 2. To start it again: set lactnet mail 3. To unsubscribe: unsubscribe lactnet 4. To get a comprehensive list of rules and directions: get lactnet welcome