In the March 24 edition of the OT magazine Advance for Occupational
Therapists there is an article by a Dr. David Lain (from the Medical College
of Georgia in Augusta)  titled "Jaundice Still A Concern in NICU" that made
me think how glad I am to subscribe to Lactnet. I was not impressed with this
article as a whole, or even with most of its parts. It mentions the NICU only
in passing; there is no reference to the frequence of jaundice >20mg/dl in
the population;  much of this info seems outdated; and it neglects to talk
about the high incidence of jaundice <16 mg/dl in normal newborns and that it
is usually benign. The following paragraph is what I would appreciate my
fellow Lactnetter's assistance with, specifically in providing me (either via
list or private e-mail) with published documents that I can quote when I
respond to the magazine in writing.
    "Breastmilk jaundice is associated with increased amounts of
nonesterified fatty acids (NEFA) found in the milk of some women. NEFAs are
in vitro inhibitors of the tranferase that conjugates bilirubin. They also
bind to the Z protein in competition with bilirubin. The exact mechanism
leading to prolonged breastmilk hyperbilirubinemia has not been clarified.
      Breastfeeding infants with this condition may require interruption of
breast feeding for several days if their bilirubin approaches level
necessitating intervention.Some studies show there is no difference between
the bilirubin concentration of bottle fed and breastfed babies, suggesting
the breast milk jaundice may be sometimes linked to local institutional
practices like the timing of the first feeding, frequency of feeding,
variations in maternal support, and types of intrapartum and postpartum
medications used. "
    The article lists the indications for exchange transfusions, and spends
more than a fourth of the printed material discussing the role of
phototherapy in treatment, including the risk of  "eye patches blocking nasal
and oral passages, causing a potential for suffocation." Has anyone ever
heard of the eye patches used in phototherapy being a risk for suffocation?
Does anyone have any good, brief but complete, articles or references to
educate this M.D. (as well as the rest of the readers) on the importance of
continuing breastfeeding to reduce jaundice, as well as any updated research
on jaundice in general. Thanks!

Debbie Rabin, OTR, CLC
Los Angeles, CA