Hello all,

I've just read the abstract of this paper (not the whole article infortunately) and was also struck that the mean of the control group was 8.3mg/dL at day four. Not carrying the numbers around in my head (well, not since the exam!) I looked it up in the excellent chapter on jaundice by Dr Gartner in Riordan. In the risk designation graph, a level of 8.3mg/dl is well within the "Low Risk Zone" for 96 hours. The treated infants had their bili levels reduced below the mean levels of the controls. This also suggests to me that it seems that the researchers are "messing" with a normal process. Only an 'theoretical expert' on jaundice and an n=1 on the practical side, but I remember when studying that what really srtuck me about neonatal jaundice was how the physiology / biochemistry means that the neonate is immature / systems not well developed enough to clear bilirubin as effectively as an older child or adult (check out page 312 in the newest Riordan if your memory needs refreshing!). It seems that there is a rate-limiting factor for every step of bilirubin excretion. I'm wondering whether this is an adaptive function or just pure immaturity / suboptimal evolution? Also wondering whether there are any animal models that have studied this?

But back to this study. I too find it a bit disturbing that one would try to inhibit a "normal" physiological process, i.e. decreasing the mean levels which are also known not to be a problem - levels which actually might be an adaptive protective mechanism in the neonate (but I think this question is not clearly answered yet). On the other side, wouldn't it be wonderful to have an easier way to decrease bili levels for those really at risk, one that wouldn't interfere with breastfeeding at all? Although it could be open to unecessary use. I think the aim of this research is not to undermine breastfeeding, although I haven't got my hands on the full version of the article. 
Such developments could be very positive, so long as they are used alongside optimal knowledge of breastfeeding management and jaundice. 

Sara Bernard Bsc (hons biology)
The Netherlands

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