RT Journal
A1 Watkinson M
T1 FOrmula for jaundiced breast-fed infants
JF Archives of Pediatrics & Adolescent Medicine
JO Archives of Pediatrics & Adolescent Medicine
YR 1999
FD June 1
VO 153
IS 6
SP 657
OP 658
DO 
UL http://dx.doi.org/
AB 
With a mean ± SD phototherapy-starting bilirubin level of 259 ± 20 µmol/L, only 2.3% of Tan's subjects would have had a total bilirubin level of 300 µmol/L or higher. Many pediatricians would not treat even that level of jaundice in a well full-term baby after 48 hours. Furthermore, the 95th percentile for maximum total bilirubin concentration in breast-fed babies in one study was 248 µmol/L,3 and so almost 50% of Tan's cases were below that percentile when treatment started. Although changes in the brainstem evoked responses are reported at levels above 255 µmol/L, long-term bilirubin toxicity is rare in full-term babies without hemolysis.4 Newman and Maisels,4 when advocating "a kinder, gentler approach" to jaundice, suggested interrupting breast-feeding at a bilirubin level between 275 and 425 µmol/L, but they also told parents that there is no firm evidence that the benefits of any of these maneuvers outweigh the risks. So much for the starting threshold, but the simplest and most important measure that Tan might have undertaken to reduce the duration of phototherapy would have been to stop it after 24 hours when the mean bilirubin level was less than 225 µmol/L in all the groups.