Dear Judy,

I was lucky enough to have a little time to look around our medical library
 this week (usually I am too busy to leave my office).  There was an article
in the October 1994 issue of Pediatrics called "Practice Parameter:
Management of Hyperbilirubinemia in the healthy Term Newborn."  There was an
algorithm that appeared on pages 536-565.  The corrected algorithm is in Vol
95, 1995 on pages 458 - 461.  They recommend phototherapy in the infant of
25-48 hr old if total serum bili is 15, in the 49-72 hour infant if the bili
is 18 and in the >72 hour old if bili is 20.

I've never understood the rationale behind giving oral glucose water to a
hypoglycemic baby.  There are only 20 cal in a 4 oz bottle of glucose water.
  Assuming that a baby could get 1 oz down it would be 5 calories,
approximately the amount in 1/4 oz colostrum.  Plus, glucose water is a
simple sugar which might cause a rebound effect in some babies.  Colostrum is
high in protein which tends to affect blood sugar more slowly.  It seems to
me that if a baby is in real danger from hypoglycemia that an IV should be
started.  Why wait for digestion to take place?  Maybe if formula companies
started making  dextrose IVs and marketing them as hypoglycemia prevention
products babies would not have to get artificial nipples!  In my hospital we
have an East Indian ped who takes all jaundiced babies off the breast because
it is "breastmilk jaundice".  One mother (who was a resident physician) had
her baby taken off the breast after 1 feeding and kept off for a week until
the jaundice sufficiently subsided (breastmilk jaundice, you know!).  My
question is, " if it is breastmilk jaundice when the baby is breastfed, why
wasn't this jaundice called formula jaundice?"--especially since the baby was
only fed at breast 1 time (potent stuff that human milk to persist in its
jaundice causing ability for 1 week!)

Martha Grodrian Brower RD LD IBCLC
Dayton, OH