Is Breastfeeding Really Favoring Early Neonatal Jaundice?

Abstract

ABSTRACT. Objective. The purpose of this study was to evaluate the development of significant hyperbilirubinemia in a large unselected newborn population in a metropolitan area with particular attention to the relationship between type of feeding and incidence of neonatal jaundice in the first week of life.Study Design. A population of 2174 infants with gestational age >37 weeks was prospectively investigated during the first days of life. Total serum bilirubin determinations were performed on infants with jaundice. The following variables were studied: type of feeding, method of delivery, weight loss after birth in relationship to the type of feeding, and maternal and neonatal risk factors for jaundice. Statistical analyses were performed using the z test for parametric variables and the t test for nonparametric variables. In addition, the multiple logistic regression allows for the estimation of the role of the individual characteristics in the development of hyperbilirubinemia. Data concerning serum bilirubin peak distribution in jaundiced newborns were analyzed using a single and a double Gaussian best fit at least squares. The t test was performed to compare 2 values (high and low) of the serum bilirubin peak in breastfed and supplementary-fed infants with those in bottle-fed infants.Results. The maximal serum bilirubin concentration exceeded 12.9 mg/dL (221 mol/L) in 112 infants (5.1%). The study demonstrated a statistically significant positive correlation between patients with a total serum bilirubin concentration >12.9 mg/dL (221 mol/L) and supplementary feeding; oppositely, breastfed neonates did not present a higher frequency of significant hyperbilirubinemia in the first days of life. However, best Gaussian fitting of our data suggests that a small subpopulation of breastfed infants have a higher serum bilirubin peak than do bottle-fed infants.Newborns with significant hyperbilirubinemia underwent a greater weight loss after birth compared with the overall studied population, and infants given mixed feeding lost more weight than breastfed and formula-fed newborns, indicating that formula has been administered in neonates who had a weight loss beyond a predetermined percentage of birth weight. Significant hyperbilirubinemia was also strongly associated with delivery by vacuum extractor, some perinatal complications (cephalohematoma, positive Coombs' test, and blood group systems of A, AB, B, and O [ABO] incompatibility) and Asian origin. Multiple logistic regression analysis shows that supplementary feeding, weight loss percentage, ABO incompatibility, and vacuum extraction significantly increase the risk of jaundice, while only cesarean section decreases the risk.Conclusion. The present study confirms the important role of fasting in the pathogenesis of neonatal hyperbilirubinemia, although breastfeeding per se does not seem related to the increased frequency of neonatal jaundice but to the higher bilirubin level in a very small subpopulation of infants with jaundice. In fact, in the breastfed infant...

211 G to A Variation of UDP-Glucuronosyl Transferase 1A1 Gene and Neonatal Breastfeeding Jaundice

“…Decreased caloric intake, inhibition of hepatic excretion of bilirubin, and an increase in intestinal absorption of bilirubin (enterohepatic circulation) are suggested mechanisms for early neonatal hyperbilirubinaemia associated with breastfeeding (24). Recently, a large population study showed the important role of fasting, but not breastfeeding per se, in the pathogenesis of neonatal hyperbilirubinemia (26). In addition, Ishihara et al (27) demonstrated that mutation in the TATA box or in the coding region of UGT1A1 was found to have significantly higher increment of serum bilirubin values in healthy adult subjects than individuals without any mutation after caloric restriction.…”

Investigation of the Potential Risk Factors of Indirect Hyperbilirubinemia in Patients Admitted to the Neonatal Intensive Care Unit with Hyperbilirubinemia

“…Sezaryen ile doğanların yatış bilirubin düzeyi ortalaması 16,89±3,6, NSVY ile doğanlarınki 17,2±3,65 idi. Doğum şekline göre yatış bilirubin düzeyi benzer bulundu (p:0,48) beslenen bebeklerin bilirubin düzeyinin daha düşük olduğu gösterilmiştir (21). Tan ve ark'nın çalışmasında olguların %18,2'de patolojik tartı kaybı saptanırken, bizim çalışmamızda patolojik tartı kaybı oranı %6,4ʼidi (16).…”

The predictive value of 6-12th hour and 24th hour bilirubin levels in determining significant hyperbilirubinemia among healthy term neonates

“…Bertini ve ark. [19] 2174 yenidoğan ile yaptıkları çalışmada beslenme şekli, tartı kaybı, doğum şeklinin belirgin hiperbilirubinemi gelişmesine etkisini incelemişlerdir. Anne sütü alan bebeklerde ilk günlerde belirgin hiperbilirubinemiyi sık bulmamışlardır.…”