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. *********************************************** Archives: http://community.lsoft.com/archives/LACTNET.html Mail all commands to [log in to unmask] To temporarily stop your subscription: set lactnet nomail To start it again: set lactnet mail (or [log in to unmask]) To unsubscribe: unsubscribe lactnet or ([log in to unmask]) To reach list owners: [log in to unmask]