XL15: Bilirubin Management and Implications for Breastfeeding

Lecturer: Lawrence Gartner
CERPs: 1.0 L CERP
Cost: US$15.00
Access period: One week
Lecture recorded: at GOLD09
Synopsis:  Although neonatal jaundice is a common occurrence in both breastfed and artificially-fed infants, there are some special relationships between breastfeeding and jaundice in newborns. These will be explored by first examining the question of why and how jaundice or hyperbilirubinemia is a risk for newborns.
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About the lecture: Although neonatal jaundice is a common occurrence in both breastfed and artificially-fed infants, there are some special relationships between breastfeeding and jaundice in newborns. These will be explored by first examining the question of why and how jaundice or hyperbilirubinemia is a risk for newborns. The brain disorder known as "kernicterus" will be defined. The scenario of a badly managed case which resulted in development of kernicterus will be presented. Bilirubin metabolism will be examined with diagrams to understand how the newborn differs from the older child and adult in the six specific steps of this process: 1) synthesis; 2) transport; 3) hepatic uptake; 4) hepatic conjugation; 5) hepatic excretion; 6) intestinal reabsorption. The additonal differences in bilirubin metabolism between the breastfed and the artificially-fed infant will then be explored to understand why breastfed infants normally have a prolonged period of jaundice and hyperbilirubinemia and why some breastfed infants have abnormal exaggerations of jaundice and hyperbilirubinemia. The entities of "Breastmilk Jaundice" and "Starvation Jaundice of the Newborn" will be defined. Using guidelines from the American Academy of Pediatrics, the talk will explore how to identify the infant at increased risk for exaggerated neonatal jaundice and how to assure good follow-up of the high risk infant. Methods for optimizing breastfeeding while controlling hyperbilirubinemia will be explored in detail. The ultimate goal of the talk is to enable the health practitioner to assist in maintaining breastfeeding while protecting the infant from the rare, but very real, risk of developing bilirubin-related brain damage.

About the lecturer: Prof Lawrence Gartner specialized in neonatology and pediatric liver disease during his pediatric training. He was Professor of Pediatrics and Director of the Children's Clinical Research Unit at Albert Einstein College of medicine and later, appointed as Professor and Chairman of the Department of Pediatrics at The University of Chicago and Director of Wyler Children's Hospital. The great majority of his basic laboratory and clinical research has been in the area of neonatal jaundice, with particular reference to its relationship to breastfeeding. He is a past-president of the Academy of Breastfeeding Medicine and currently Professor Emeritus, Departments of Pediatrics and Obstetrics/Gynecology at The University of Chicago.