Late preterm infants not only are at a higher risk for jaundice but their clearance of meconium is slower than a full term infant. Supplementing such a breastfed baby with standard formula because "it binds bilirubin" is obviously incorrect. There is a hierarchy of interventions that can be undertaken with a late preterm infant with poor feeding skills and climbing bili levels. Once efforts to improve feeding at the breast have been exhausted to increase calories,?and supplementation has been determined to be medically necessary, then expressed colostrum/breastmilk or banked human milk are the next choices. If none of these are available then a casein-based hydrolysate formula could be used as it has been mentioned that it may contribute to better reduction in bilirubin levels than a standard formula (Gourley et al, 1999). This may be because it contains L-aspartic acid,?a B-glucuronidase inhibitor (Gourley et al, 1997). It also reduces the risk of provoking allergies or diabetes in susceptible infants. Gourley et al (2005) gave breastfed babies 5mL does of L-aspartic acid during the first week of life which showed no interruption of breastfeeding and an increase in fecal bilirubin excretion.

Gourley GR, Kreamer BL, Cohnen M. Inhibition of beta-glucuronidase by casein hydrolysate formula. J Pediatr Gastroenterol 1997; 25:267-272

Gourley GR et al. Neonatal jaundice and diet. Arch Pediatr Adolsec Med 1999; 153:184-188

Gourley GR et al. A controlled, randomized, double-blind trial of prophylaxis against jaundice among breastfed newborns. Pediatr 2005; 116:385-391

Always ask the other guy for their evidence when clinical interventions are implemented that don't make sense or are not evidence-based.

Marsha Walker, RN, IBCLC
Weston, MA



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