Q: My son is 3 months old and has physiological jaundice from day 3. His Serum Bilirubin level went up to 15 on day 5. He underwent phototherapy and it came down to 10. As per our doctor's advice, we have been keeping him exposed to sunlight since then. But a week back, when we checked his S. Bilirubin again, it was still 3.1. Our doctor suspects breast milk jaundice. He has prescribed Gardenal and Udiliv. What is the action of these 2 medicines?

A:The fact that your son did not have jaundice at birth is a very good sign. It means that his bilirubin was being adequately disposed off by the mothers liver. As correctly diagnosed, he suffered from physiologic neonatal jaundice which is now becoming increasingly common. A very large hospital in New Delhi is reporting up to 80% of the neonates as suffering from this temporary disorder. Hence there is nothing unusual about this problem. Even in physiological jaundice, serial bilirubin estimations are very helpful till it reaches normal level. This enables us to determine if bilirubin ever came down to normal or got stuck at 3.1 mg on its downward journey. If the level went down to, say, less than 2mg and then rose, it can be reasonably diagnosed as breast milk jaundice. On the other hand, if the downward slide has been slow (i.e. it took say 10 weeks to drop from 15 mg to 3.1 mg), one would assume that infants liver is slowly developing and learning to tackle bilirubin. In such a situation, one need not do anything (except bilirubin estimation at weekly intervals) since it will slowly come down to normal. Even if the infant is having breast milk jaundice (due to certain fatty acids and certain other compounds like pregnandiole in milk), a level of 3.1 mg is quite harmless and will come down in due course. Breast milk feeding can continue since it is the infants liver development that takes care of the problem. Active medication is resorted to only when the level is inching towards potentially toxic levels i.e. 15 mg or more. Phenobarbital (Gardenal) is an enzyme inducer which is generally given for other, more serious, causes of high bilirubin such as Crigler-Najjar Syndrome, Gilberts syndrome etc. Udiliv is the brand name of a medicine called ursodesoxycholic acid (UDCA). It is approved for use in dissolution of certain types of gall bladder stones and chronic liver disease. Unfortunately it is sometimes prescribed for other conditions for which there is no evidence of either safety or efficacy. UDCA is not permitted to be used in children, leave alone infants, in all advanced countries such as United States, Britain, Australia etc. In view of the concern and anxiety which any problem with an infant causes to parents, I always routinely suggest a second opinion from another paediatrician.