Significant weight loss in breastfed term infants readmitted for hyperbilirubinemia

Abstract

BackgroundWeight loss of greater than 7% from birth weight indicates possible feeding problems. Inadequate oral intake causes weight loss and increases the bilirubin enterohepatic circulation. The objective of this study was to describe the association between total serum bilirubin (TSB) levels and weight loss in healthy term infants readmitted for hyperbilirubinemia after birth hospitalization.MethodsWe reviewed medical records of breastfed term infants who received phototherapy according to TSB levels readmitted to Caja Petrolera de Salud Clinic in La Paz, Bolivia during January 2005 through October 2008.ResultsSeventy-nine infants were studied (64.6% were males). The hyperbilirubinemia readmission rate was 5% among breastfed infants. Term infants were readmitted at a median age of 4 days. Mean TSB level was 18.6 ± 3 mg/dL. Thirty (38%) had significant weight loss. A weak correlation between TSB levels and percent of weight loss was identified (r = 0.20; p < 0.05). The frequency of severe hyperbilirubinemia (> 20 mg/dL) was notably higher among infants with significant weight loss (46.7% vs. 18.4%; p < 0.05). The risk of having severe hyperbilirubinemia was approximately 4 times greater for infants with significant weight loss (OR: 3.9; 95% CI: 1.4-10.8; p < 0.05).ConclusionsSignificant weight loss could be a useful parameter to identify breastfed term infants at risk of severe hyperbilirubinemia either during birth hospitalization or outpatient follow-up visits in settings where routine pre-discharge TSB levels have not been implemented yet.

Early Weight Loss Nomograms for Exclusively Breastfed Newborns

“…32,33 In addition, the administration of large volumes of intravenous fluid before cesarean may be an independent risk factor for newborn weight loss. 34,35 Excess weight loss $10%, which has been associated with increased risk of both hyperbilirubinemia and hypernatremic dehydration, 10,14,16,32 was common among both groups. …”

“…[8][9][10] Although the brief period of low enteral intake and weight loss is well tolerated by most newborns, some develop complications of weight loss such as hyperbilirubinemia and dehydration, the 2 most common causes of neonatal morbidity. [11][12][13][14][15][16][17] To monitor for potential morbidity, weight and jaundice are evaluated daily during the birth hospitalization, with weight generally decreasing and bilirubin levels generally increasing. A nomogram published in 1999 depicting bilirubin levels by hour of age 18 is widely used to evaluate trajectories of neonatal hyperbilirubinemia 19 and has been incorporated into the American Academy of Pediatrics guideline on hyperbilirubinemia management.…”

Hospital re-admission of late preterm or term infants is not a factor influencing duration of predominant breastfeeding

“…In our study, jaundice was the most common reason for readmission within the first 10 days after birth. Though late and persistent jaundice, ‘breast milk jaundice’ is associated with exclusive breast milk feeding, early jaundice is often associated with insufficient lactation and increased weight loss 8 25…”

A Retrospective Evaluation of Etiology in Neonatal Jaundice İnfants Were Treated With Phototherapy

“…[7] bebeklerde belirgin kilo kaybının hiperbilirubinemi ile kuvvetli ilişkili olduğunu belirtmiş, ciddi hiperbilirubinemide bu riskin yaklaşık dört kat fazla olduğunu göstermişlerdir. Yine başka bir çalış-mada hiperbilirübinemili bebeklerin %11.1'inde yetersiz beslenme ve aşırı tartı kaybı (doğum ağırlığının >%10) tespit edilmiştir.…”