Re: Guidelines for detection, management and prevention of hyperbilirubinemia in term and late preterm newborn infants (35 or more weeks’ gestation) – Summary. Paediatr Child Health 2007;12(5):401–7

To the Editor,

I would like to comment on the Canadian Paediatric Society statement on the guidelines for jaundice published in the May/June issue of Paediatrics & Child Health.

On at least two occasions the statement mentions breastfeeding being a risk factor for hyperbilirubinemia. This is an unfortunate way of putting it, is very misleading and inaccurate, as well as reinforces the prejudices of many health professionals with regard to breastfeeding. Early-onset hyperbilirubinemia is not due to breastfeeding or breastmilk, but to the lack of breastmilk. The study by Bertini et al (1), not referenced in the statement, backs up our clinic’s extensive clinical experience of what is really happening and what the real issue is.

Support for breastfeeding in most Canadian hospitals is so poor that many babies are not breastfeeding well until the milk ‘comes in’ and are, in fact, only pretending to breastfeed. There is not a large volume of colostrum available in the first few days, but there is enough, if the baby gets it. Because of poor intake of breastmilk, one cannot say that they are breastfeeding, which leads directly to hyperbilirubinemia due to an increased enterohepatic circulation of bilirubin.

I appreciate the paragraph on supporting breastfeeding and it is well stated. But unfortunately, individuals experienced in helping mothers breastfeed well are not always easy to come by and paediatricians rarely figure among them. What is necessary is an upgrading of breastfeeding knowledge and skills of the nursing staff and physicians (particularly paediatricians) who deal with newborn babies