Carrie asked, <<"...the doctor said that formula helps binds with the
bilirubin better to get it lower quicker."  I know this is not true, but
I want to confront this doctor with some actual research or written
information.  Is there any truth to what this doctor said and does
anybody have any articles that I could bring to this doctor?" >>

We've had a problem or two with jaundice around here lately so I dove
into the subject a little. I recommend Hale & Hartmann's Textbook of
Human Lactation. It has an entire chapter on the topic, written by Dr
Gartner.  Here are some excerpts, from page 259-260 in the section on
"Physiologic jaundice of the newborn & prolonged physiologic jaundice
(breastmilk jaundice)":

<<< "Serum bilirubin concentrations in newborns with physiologic
jaundice of the newborn differ greatly between breastfed and
artificially-fed infants after the fifth day of life (figure 4).  In
artificially-fed infants, the serum bilirubin concentration falls to the
adult normal range of less than 1.5 mg/dl by about the 11th day of life
(Gartner et al., 1977). In contrast, the great majority of normal
breastfed infants have persistence of serum bilirubin concentrations
greater than 1.5 mg/dl for three to, rarely, 15 weeks of life (DeAngelis
et al., 1980; Alonso et al., 1991; Gourley et al., 1999; Mauro et al.,
2000)....This pattern of prolonged, unconjugated hyperbilirubinemia in
the healthy breastfed infant is called breastmilk jaundice. It is a
normal and expected prolongation of physiologic jaundice seen in at
least two-thirds of all newborns. Breastmilk jaundice does not begin
until the appearance of significant amounts of transitional and mature
milk at about the fifth day of life." >>>

Two paragraphs later Dr Gartner says, "The great majority of mature
human milk, unlike cow's milk and infant formulas, increase the
intestinal absorption of unconjugated bilirubin, as shown in animal
studies (Gartner et al., 1983; Alonso et al., 1991).  Colostrum does not
have this effect, accounting for the fact that breastmilk jaundice does
not occur in the early days of life (Gartner et al., 1977).  The
component of human milk responsible for this enhancement of intestinal
bilirubin absorption has not be (sic) defined, nor is the precise
mechanism for transport of bilirubin from the intestinal lumen into the
circulation understood."

Further down page 260 he says that "Supplementation of breastfeeding
with cow's milk formula results in an accelerated decline in serum
bilirubin because these preparations interfere with intestinal bilirubin
absoprtion (Gartner et al., 1983)."

There's much more in the textbook.  Check it out.

I notice than in your case the baby was born a bit early. That can
aggravate the bilirubin situation.  I'm not sure what's best to do in
your case (you said in your post that the baby is only 2 days old) but I
thought the info from Hale/Hartmann would be useful to you. I hope it
is!
 

Regina M. Roig-Romero, BS IBCLC 
Senior Lactation Consultant 
Miami-Dade County Health Dept WIC/Nutrition 
Breastfeeding Program 
7785 NW 48 ST, Suite 300 
Miami FL 33166 

(786) 336-1333 x162 
(786) 336-1345 fax 
(786) 336-1336 Breastfeeding Helpline 

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