> 6-day-old infant, bili 18.  Pediatrician suggested pumping and feeding EBM for
> 18 hours.  Ped. told the mother that EBM was different than directly-nursed
> milk, and that it was more effective in treatment of jaundice.
>
I think I can shed light. EBM is not different from "fresh", except you
can get adequate amounts into a sleepy jaundiced infant easier. The clue
is in the bili level. In my experience, bili levels >10-12 cause extreme
sleepiness which interferes with the baby's ability to consume adequate
colostrum (which is the treatment factor here). Bottle feeding overcomes
the sleepy factor and gets the milk in. In this case, 18 hours of "force
feeding" colostrum in a 6-day old (with a newly functioning liver for a
day or so) should bring the bili down to low enough levels (not normal
levels, but low enough for wakefulness at feeding times) to allow direct
nursing.

I did home phototherapy over a period of a few years and found - to my
incredible surprise - that bottle feeds with bili levels *greater than
10* did *not*, I repeat, *not* cause nipple preference. It was almost as
if the sleepiness of the higher bili levels caused an amnesia of sorts
regarding suck memory. So, take advantage of this - get the
milk/colostrum (especially colostrum) into the baby by whatever means
to bring the bili down (I have moms offer the breast first even so, but
if the baby is too sleepy after 10 minutes of trying to waken by all the
usual means, to give the feeding by bottle - her milk preferably, but
ABM is the acceptable alternative in this case), pump of course, and as
soon as the bili is close to 10-12, go back to full-time breastfeeding
again. The babies seem not to "remember" their bottle experience.
Strange. But this approach sure helps support the parents through those
fearful days, giving them a sense of control and confidence, and
preserves breastfeeding to boot. What a bargain!

Katharine