The American Academy of Pediatrics published a Practice Parameter
on Management of Hyperbilirubinemia in the Healthy Term Newborn in
Pediatrics, 1994 (October), 94:558-561.  A specific recommendation for the
breastfed infant is included on page 561: "The AAP discourages the
interruption of breas-feeding in healthy term newborns and encourages
continued and frequent breast-feeding (at least eight to ten times every 24
hours). [I would now increase that to 10 to 12 times every 24 hours]
Supplementing nursing with water or dextrose water does not lower the
bilirubin in jaundiced, healthy, breast-feeding infants."  There is an
accompanying table that lays out the options for management of the
breastfed infant, including to "observe" the baby without interruption of
breastfeeding or institution of phototherapy. Supplementation of
breastfeeding is also suggested, but none of these therapies would be
indicated in a full-term, healthy infant older than 72 hours unless the
total bilirubin reached or exceeded 20 mg/dl.  At younger ages the
guidelines in the other table in the article would apply to the breastfed
infant as well as the artificially-fed infant.  This AAP Practice Parameter
is an official guideline from the American Academy of Pediatrics and is
fully documented with references.
        An additional article that may be of help is my review article
entitled "Neonatal Jaundice", which appeared in Pediatrics in Review, 1994
(November), 15:422-432.  Pediatrics In Review is also an official
publication of the American Academy of Pediatrics and its articles are part
of the continuing medical education program of the AAP.
        Both of these articles should be respected by practicing
pediatricians.
                        Larry Gartner


Lawrence M. Gartner, M.D.
Professor of Pediatrics and Obstetrics/Gynecology
The University of Chicago
MC6060
5841 S. Maryland Avenue
Chicago, IL 60637
Phone: (773) 702-0389
FAX: (773) 702-0764
E-Mail: [log in to unmask]