Also in the Clinical Pediatrics of June, 1996 is an article on "Therapeutic
Approaches to Neonatal Jaundice: An International Survey" by Thor Willy Ruud
Hansen, MD, PhD.

It was interesting in its discussion of the current AAP recommendations "There
is little doubt that jaundice is an essentially benign phenomenon in the
majority of healthy term newborns.  However, several invited commentators to the
paper by Newman and Maisels suggested that before a 'Kinder, gentler approach'
can be fully embraced, we need to know more about the consequences for babies
who are not in that majority."

His article is a report on an international survey he performed in which he
found "great variability between units in the level of serum bilirubin that
would trigger therapy.  This applied across weight groups and to phototherapy as
well as exchange transfusion.  The significant heterogeneity in our approach to
the treatment of jaundiced neonates suggests that our understanding of the
biology of neonatal jaundice is inadequate and that further research will be
necessary in order to provide a more solid biological foundation for therapy."

We can only hope that when this "further research" is conducted, that exclusive
breastfeeding and its effect is studied also.  Too often at our hospital a baby
with a "high" bili count is taken off breastmilk even when baby is active,
alert, stooling often and growing.  Then they are sure that baby is VERY sick
when he becomes lethargic when separated from mom, put under bili lights and
given first Nothing by mouth then glucose then formula...

He mentioned "intermittent phototherapy" as a way of overcoming "potential side
effects of phototherapy, as well as the desire to further bresat milk nutrition
and lessen anxiety for the parents".  And was surprised that only 12% of the
participating NICU's administer phototherapy this way.

- I would like to know the protocol for intermittent phototherapy as this is not
used at our NICU either.  Anyone have this???

Even though this article is not directly related to breastfeeding, I thought you
would like to know about it.

Jeanette Panchula, BSW, LLLL, IBCLC, RN
Puerto Rico'
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