I agree that this dr is being overly cautious re: bili levels for a full
term, healthy 9 lb baby. A 15 needs to be evaluated as to possible source
and if probably physiologic simply needs to be monitored as to whether or
not it is going up or down, if up-how fast?
The article he may be alluding to is "Hyperbilirubinemia in the Breast-Fed
Newborn: A Controlled Trial of Four Interventions." Martinez, Maisels,
Otheguy, Garcia, Savorani, Mogni & Martinez. Pediatrics 91(2), 470-473.
Feb. 1993.
In my reading I found another interesting article by Dr. Maisels from
Pediatric Annals 25(10), 547-552. Oct 1995. "Clinical Rounds in the
Well-Baby Nursery: Treating Jaundiced Newborns." At the end of the article
he has 10 Pearls (or pitfalls) in the management of jaundiced newborn. 1.
Remember to take a history (previous sibs with j. and family ethnicity).
2. Don't ignore jaundice in the first 24 hours - it is considered
pathological until proven otherwise. 3. Don't treat 35 to 37 week
gestation infants as if they were full term infants. (They are not as
vigorous and do not nurse as well as full term infants, more inclined to
have bili >13, shouldn't go home before 48 hours). 4. Document your
assessment, particularily if the infant is discharged early. 5. A rising
late bili is typical of G6PD deficiency (consider ethnicity, sex of
infant). 6. Don't use homeopathic doses of phototherapy [in other words,
do it or don't]. 7. Don't ignore a failure of response to phototherapy.
8. Provide timely follow-up. Infants discharged prior to 48 hours should
be seen by a health care professional within 2-3 days of discharge. 9.
Don't ignore prolonged jaundice. [Be sure it is indirect, not direct
bilirubin-biliary atresia; be sure the newborn screen for thyroid is
normal-prolonged high indirect bili may be congentital hypothyroidism;
check color of urine and stool -cholestasis. 10. Don't ignore severe
jaundice. If the bilirubin is sufficiently elevated, kernicterus can occur
in a healthy, breast-fed infant [ :-( ]. Hope this doesn't bore you all
:-)
I may be wrong, but I think the reason formula seems to be more
effective is dependent on volume and force feeding an adequate amount.
Calories are what help get rid of bilirubin. Sincerely, Pat in SNJ
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