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Date: | Tue, 10 Feb 2004 09:38:40 -0600 |
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The AAP has relatively few treatment guidelines, but the one on
hyperbilirubinemia (http://www.aap.org/policy/hyperb.htm) makes it pretty
clear that interrupting breastfeeding is NOT the standard of care but that
many physicians do it anyway.
Breast milk jaundice IS real; that is, bf babies have higher mean
bilirubins. For some references see http://www.aap.org/mrt/bfv.htm . The
real question is, does it mean anything clinically? (i.e. can it cause
kernicterus?) Probably not, but since no one will do a dbrc trial we don't
know.
Stopping breastfeeding to offer soy formula makes no sense either. I'd also
want to know why 3 days was picked for bf cessation. Seems sort of
arbitrary.
NB: Alk phos levels are always "high" in infants and children -- it reflects
normal bone growth. The "normal" values that most hospital labs list
(unless it is children's hospital) are for white men. Infant alk phos
normals 150-420 (The Harriet Lane Handbook is an excellent reference for
normal ranges for kids for hemoglobin, BP, heart rate, etc.)
Good luck!
Suzanne
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Suzanne Berman, M.D., FAAP
[log in to unmask]
Plateau Pediatrics
49 Cleveland Street, Suite 210
Crossville, Tennessee
voice (931) 707-8700
fax (931) 456-0802
after hours (931) 484-9511
www.plateaupediatrics.com
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