Hi -

Can't add anything more to the "green breastmilk" issue than has already been
said many times, but I did want to say that black stools after starting
phototherapy is something I consider normal,   I have noticed return to
greenish/black stools more times than I can count over 20-some years of
Maternal/Child nursing.  However, this is not precisely because the
"bilirubin is breaking down" as the nurse stated, since the phototherapy
light tends to cause some of the bilirubin to become water soluble, and
therefore is excreted in the urine-see Breastfeeding and Human Lactation by
Jan Riordan and [our own] Kathleen Auerbach , top of page 338. My
understanding is that the emphasis on the need for adequate intake (of
breastmilk, I hope), the effort to resolve feeding problems, and indeed the
reduction of the bilirubin level from the lights (which should decrease the
infant's lethargy, and therefore increase his intake), will increase the
number of stools.  This in turn allows the unconjugated, fat soluble
bilirubin to be excreted with the stool and not reabsorbed (which is
frequently what caused the jaundice in the first place).

I have worked in several states around the country over the years.  There are
plenty of other nurses who also regard what is called "bili light stools" as
normal shortly after starting phototherapy.  If this is a shock to anyone,
it's not that we didn't chart the greenish black stool - and I have watched
numerous MD's recoil from barrage of it during an examination without
questioning the color.  Now that I think about it more, maybe one or two
doctors did double check with an analysis, but found nothing.  But the last
time I saw this done was over 10 years ago.

Hope this helps - also hope I was coherent as it's getting quite late and
it's way past my bedtime!

Donna L. Coe RN IBCLC
Syracuse, NY   USA