Hi Natalie
Hmmm ... the reason why a single article has been so influential might lie
in a cultural distrust of breastfeeding and breastmilk (actually of women's
bodies generally but there are not enough hours in a day to go there!).  Our
medical fraternity is quick to distrust breastmilk and breastfeeding.  This
is why the simple solutions (breastfeed more often; maintain near constant
skin to skin contact for the first 48hrs; allow pregnancy to complete its
full term (38-42 weeks) are over looked for the technological (man-made)
ones.  Supplementing with anything other than mother's own milk is an
intervention that should not be made lightly.  As a community, we are waaay
to comfortable with bottle-feeding and waaaay to suspicious of women's
bodies' capacity to adequately nourish an infant.  A friend of mine has been
heard to reassure mothers with the words, 'women's bodies are
over-engineered to breastfeed'.  We are designed to do it and to do it well.
If the medical system could just get the h@#l out of the way, we would see
far fewer cases of 'lactation failure'. There is some discussion in the
archives addressing the notion that some jaundice is physiologic (and
bilirubin is an important antioxidant).
Best
Nina Berry
University of Wollongong 
Australia

-----Original Message-----
From: Lactation Information and Discussion
[mailto:[log in to unmask]] On Behalf Of Natalie Davis
Sent: Monday, 17 September 2007 3:44 AM
To: [log in to unmask]
Subject: [LACTNET] breastfeeding supplements to prevent jaundice

I am a nursing student at Ivy Tech Community College. I recently gave a
presentation on newborn jaundice.  During my research, I frequently saw
that breastfed babies were more likely to become jaundiced.  As I learned
more I understood it is mostly in breastfed babies that aren't starting
out well with breastfeeding-not getting as much as they need, thus not as
many bowel movements and less bilirubin removal.  Many articles
recommended breastfeeding more frequently as the first answer with
supplementing being the next step.  It led me to wonder what ingredient in
breastmilk versus formula increases jaundice.  As I looked deeper, I came
across several articles referenced below that mention possible supplements
to "fix" the isssue while still recommending exclusive breastfeeding.  The
best synopsis I can give after reading many articles is that
ß-glucuronidase which naturally occurs in breastmilk (and newborns)
somehow increases the reuptake of bilirubin in the intestines instead of
allowing it to pass.  The study conducted in the articles below researched
the introduction of B-glucoronidase inhibitors as a supplement given
orally with each breastfeeding occurrence.  All those given showed some
faster bilirubin clearance time; however, it was a small limited study. 
One of the B-glucoronidase inhibitors used was whey/casein.  Based on the
follow-up article by Dr. Bhutani this study (Gourly et al)and another
study by this group led many practitioners to advocate casein hydrolysate
formula (which contains B-glucoronidase inhibitors) to speed clearance of
bilirubin in hyperbilirubinemia. He clearly rebuts this choice without
more evidence, and calls for more research. I was surprised that one study
would have such an effect in less than a year.  I didn't find any other
studies after this to either support or reject this proposed
supplementation of B-glucoronidase inhibitors. The Gourly et al study
states that in a US kernicterus registry 98% were breastfed and 1/3 of
those had no other risk factor than being breastfed. Have those of you in
practice seen any instance of kernicterus in breastfed infants you were
following?  I would appreciate your input on how often you see breastfed
babies develop jaundice that requires intervention (phototherapy), and if
your observation in those babies is that breastfeeding was not going well
beforehand.  Have you noticed more physicians advocating supplementation
of casein hydrolysate formula in the last few years since these studies? 
Thank you for your time and response.
Sincerely,
Natalie Davis

References:
Gourley, G. MD, Zhanhai Li, PhD, Kreamer, B. BS and Kosorok, M. PhD. 
(August 2005) A Controlled, Randomized, Double-Blind Trial of Prophylaxis
Against Jaundice Among Breastfed Newborns.  PEDIATRICS Vol. 116 No. 2, pp.
385-391 Retrieved September 15,2007 from
http://pediatrics.aappublications.org/cgi/content/abstract/116/2/385.

Bhutani, V.K., MD. (June 2006) Abuse of Casein Hydrolysate Formulas for
Treating Infants With Severe Hyperbilirubinemia. PEDIATRICS Vol. 117 No.
6, pp2317. Retrieved September 15, 2007 from
http://pediatrics.aappublications.org/cgi/content/full/117/6/2317.

Gourley, G. MD, Zhanhai Li, PhD, Kreamer, B. BS and Kosorok, M. PhD. (June
2006) Abuse of Casein Hydrolysate Formulas for Treating Infants With
Severe Hyperbilirubinemia: In Reply. PEDIATRICS Vol. 117 No. 6 June 2006,
pp. 2317-2318 Retrieved  September 15,2007 from
http://pediatrics.aappublications.org/cgi/content/extract/117/6/2317-a.

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