Neonatal jaundice and stool production in breast- or formula-fed term infants

Abstract

It has remained unclear whether the amount of fecal fat excreted in the stool and stool production influences the severity of neonatal jaundice. We determined the relationship between stool production, fecal fat excretion and jaundice in healthy breast-fed (BF) or formula-fed (FF) (near-)term neonates. From postnatal day 1-4, we quantitatively collected stools from 27 FF and 33 BF infants in daily fractions. Stool production and fecal fat contents were related to unconjugated bilirubin (UCB) levels, as determined by transcutaneous bilirubinometry (TcB). Bilirubin concentrations and stool production did not differ between FF and BF neonates during the study period. Neonatal bilirubin levels were not inversely correlated with stool production. FF and BF infants had similar fecal fat excretion rates. The stool production of FF infants was profoundly lower in the present study than in a 1985 study by De Carvalho et al. [J Pediatr (1985) 107:786-790]. We conclude that increased jaundice during the first postnatal days in healthy term neonates can no longer be attributed to breast-feeding and speculate that improved absorbability of formulas since 1985 has contributed to similar fat excretion and stool production in FF and BF neonates in 2007.

Earlier Nutrient Fortification of Breastmilk Fed LBW Infants Improves Jaundice Related Outcomes

“…This has not been shown to be the case. In breastfed or formula fed near term infants, no difference was found in fecal fat excretion rates or stool production [33].…”

“…Fecal fat has also been flagged as a mechanism for bilirubin elimination. Breastfed neonates have highly efficient reabsorption of faecal fat [32], which raises the possibility that nutrient supplement or preterm formula fat may not be as efficiently reabsorbed, thus trapping fat soluble bilirubin with a consequential decrease in TSBR [33]. This has not been shown to be the case.…”

Efficacy of kangaroo mother care combined with neonatal phototherapy in newborns with non-pathological jaundice: A meta-analysis

“…Breastfeeding reduced the enterohepatic circulation of bilirubin and lowered serum bilirubin levels via the three pathways described below. (1) Breastfeeding increased neonatal feeding, providing adequate nutrition and calories to babies ( 54 ), allowing them to gain body weight ( 49 , 54 ), improving intestinal motility, and accelerating meconium excretion ( 55 , 56 ). Meconium excretion was associated with unconjugated bilirubin levels ( 54 ) and bilirubin enterohepatic circulation ( 55 , 56 ).…”

Perspectives of Jaundice and Implications

“…Initial testing is usually focused on the liver. Specific additional tests, such as viral hepatitis testing or testing to evaluate increased RBC destruction, may be requested along with or following the initial tests based on the patient's clinical findings and the physician's suspicions of the cause of the jaundice [12].…”