Hi Gail and Netters,

>The author's conclusion is :"The addition of formula to the feedings for
totally breast-fed infants, without suspension of breastfeeding, would
enhance the efficacy of phototherapy and reduce exposure time."

Back, years ago when I was involved in directing a National Phototherapy
Program, I would occasionally pull up Kathleen Auerbach's article
"Supportive management of the Jaundiced Breastfeeding Infant" for Drs. and
nurses.  Remember that one Kathy???  DeCarvalho, Klaus, and Merkatz  in
1982 did the research and showed  babies that nursed 12 times/24hrs. had
serum bilirubin concentrations of 5mg/dl, whereas those babies that
breastfed 6 times/24hrs. had serum bilirubin concentrations of about
11mg/dl.  (Frequency of Breastfeeding and Serum bilirubin Concentration. 
AM J. Dis. Child.  136: 747-48, 1982).  When Kathy was at the University of
Chicago, she noted in  twenty mother-baby couples she set up using the SNS
(Supplemental Nursing System), there was "improved nursing effectiveness
and frequency following elevation of serum bilirubin levels and lethargy." 
I am not promoting that every baby be set up with a tube-feeding device
that are at risk for jaundice.  I did find in my private practice and
working as a Home Phototherapist that those Drs. that were eager to stop
breastfeeding at the first signs of an elevated bilirubin or that wanted to
begin supplementing with formula that I would encourage them first to allow
the baby to continue to breastfeed using an SNS.  That would give the baby
a chance to avoid nipple confusion, stay at the breast, stimulate the
breast to get a good milk supply in and please the doctor.  As Kathy found
too, the babies only used the SNS for a very short time.  In fact, I will
try to put her info on the Net.  I know I have tryed putting charts on
lactnet in the past  and it looks scrambled, but here we go again.  
Duration of Use:  2 feedings or less (frequency-2) were 10%.  6-13 feedings
in 24hrs (frequency-5) were 25%.  14-23 feedings in 48hrs (frequency-8)
were 40%.  24-35 feedings in 72hrs (frequency -5) were 25%.   Kathy
concluded that the infants were nursing effectively by the end of the third
day  and in all cases, serum bilirubin levels had declined.  Also, "In all
cases, the mothers reported feeling confident about continuing to
breastfeed after the infant began nursing vigorously."  I would always
explain to the mothers that her baby did not need supplements of milk that
her milk was perfect and wonderful.  That, in fact her breastmilk helps to
get rid of the bilirubin faster by having her baby stool more often.  Just
an alternative for those tough, strange Drs. that keep insisting formula is
better for breastfeeding hyperbilirubinemia babies.  Hopefully, some day we
will convince them.   I was at a lactation party last night were we
exchanged joke gifts.  There was some really good ones.  Ironically I got a
book  titled "The Human Factor at Work:  A Guide to self reliance and
consumer protection for the mind."  Wanted to share with you the first
page.  "There is no answer.  There never has been an answer.  There never
will be an answer.  That's the answer."  by Gertrude Stein.  Have a good
day everyone.  
Pat Bull, RN, IBCLC
The Breastfeeding Connection/Medela, Inc.
Naperville, Il- where I am enjoying the sunny (Calif.-like) 50 degree
weather