In the March 24 edition of the OT magazine Advance for Occupational Therapists there is an article by a Dr. David Lain (from the Medical College of Georgia in Augusta) titled "Jaundice Still A Concern in NICU" that made me think how glad I am to subscribe to Lactnet. I was not impressed with this article as a whole, or even with most of its parts. It mentions the NICU only in passing; there is no reference to the frequence of jaundice >20mg/dl in the population; much of this info seems outdated; and it neglects to talk about the high incidence of jaundice <16 mg/dl in normal newborns and that it is usually benign. The following paragraph is what I would appreciate my fellow Lactnetter's assistance with, specifically in providing me (either via list or private e-mail) with published documents that I can quote when I respond to the magazine in writing. "Breastmilk jaundice is associated with increased amounts of nonesterified fatty acids (NEFA) found in the milk of some women. NEFAs are in vitro inhibitors of the tranferase that conjugates bilirubin. They also bind to the Z protein in competition with bilirubin. The exact mechanism leading to prolonged breastmilk hyperbilirubinemia has not been clarified. Breastfeeding infants with this condition may require interruption of breast feeding for several days if their bilirubin approaches level necessitating intervention.Some studies show there is no difference between the bilirubin concentration of bottle fed and breastfed babies, suggesting the breast milk jaundice may be sometimes linked to local institutional practices like the timing of the first feeding, frequency of feeding, variations in maternal support, and types of intrapartum and postpartum medications used. " The article lists the indications for exchange transfusions, and spends more than a fourth of the printed material discussing the role of phototherapy in treatment, including the risk of "eye patches blocking nasal and oral passages, causing a potential for suffocation." Has anyone ever heard of the eye patches used in phototherapy being a risk for suffocation? Does anyone have any good, brief but complete, articles or references to educate this M.D. (as well as the rest of the readers) on the importance of continuing breastfeeding to reduce jaundice, as well as any updated research on jaundice in general. Thanks! Debbie Rabin, OTR, CLC Los Angeles, CA