The effect of diet on feces and jaundice during the first 3 weeks of life

Gourley, Glenn R.; Kreamer, Bill L.; Arend, Richard

doi:10.1016/0016-5085(92)90862-s

Cited by 54 publications

(35 citation statements)

References 18 publications

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“…This is consistent with other studies. Gourley et al (1992) demonstrated a negative relationship between stool production and bilirubin levels in healthy term infants during the first 3 weeks of life. Semmekrot et al (2004) reported that frequent bowel movements diminished the enterohepatic circulation of bilirubin in a newborn infant, thereby increasing bilirubin excretion.…”

Section: Discussionmentioning

confidence: 92%

Baby Massage Ameliorates Neonatal Jaundice in Full-Term Newborn Infants

Sadakata

Ishida

Sekizuka³

et al. 2011

Tohoku J. Exp. Med.

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Neonatal jaundice is a common physiological problem affecting over half of all full term and most preterm infants. Thus, newborn infants must be monitored for signs of hyperbilirubinemia to prevent acute bilirubin encephalopathy or kernicterus. Evidence exists supporting the benefits of baby massage as a form of mild hand to skin contact, to increase neonatal physical and mental development. In the present study, the effects of gentle baby massage on neonatal jaundice in full term newborn infants were evaluated by a controlled clinical trial. The inclusion criteria of newborn neonates were as follows: (1) gestational age of 37 ~ 41 weeks, (2) birth weight of 2,800 ~ 3,600 g, (3) Apgar score at birth of 8 ~ 10, and (4) being a healthy neonate without neonatal asphyxia and hemolytic condition. Breastfed newborns without phototherapy were included: 20 in the massage group and 22 in the control group. We found the mean stool frequency of the massaged infants on day 1 and day 2 (4.6 and 4.3) was significantly higher than that of the control group (3.3 and 2.6) (p < 0.05). The transcutaneous bilirubin levels on the second to fifth day and serum total bilirubin levels on fourth day were significantly decreased in the massage group, compared to the control group. In conclusion, baby massage at an early stage after birth could reduce neonatal bilirubin levels. We suggest baby massage is beneficial for ameliorating neonatal jaundice.

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Section: Discussionmentioning

confidence: 92%

Baby Massage Ameliorates Neonatal Jaundice in Full-Term Newborn Infants

Sadakata

Ishida

Sekizuka³

et al. 2011

Tohoku J. Exp. Med.

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“…[1][2][3][4][5][6] Investigators in Turkey 5 and Taiwan 6 found that, at 4 weeks, some 20% to 28% of exclusively breastfed infants had total serum bilirubin (TSB) levels $5 mg/dL, but no similar data exist for infants in the United States. The cephalocaudal progression of jaundice is also well documented, [7][8][9][10][11] as is the use of a score to document this progression, 7,10,12 but the utility of this score in documenting a range of possible TSB levels, or as a predictor of subsequent hyperbilirubinemia, has been evaluated only in hospitalized newborns and not in infants seen in office practice.…”

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confidence: 99%

The Natural History of Jaundice in Predominantly Breastfed Infants

et al. 2014

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WHAT'S KNOWN ON THIS SUBJECT: Newborn infants who are predominantly breastfed are much more likely to develop prolonged hyperbilirubinemia than those fed formula, but the prevalence of prolonged hyperbilirubinemia in a largely white, North American, breastfed population is unknown.WHAT THIS STUDY ADDS: Practitioners can be reassured that it is normal for 20% to 30% of predominantly breastfed infants to be jaundiced at age 3 to 4 weeks and for 30% to 40% of these infants to have bilirubin levels $5 mg/dL. abstract BACKGROUND AND OBJECTIVES: Breastfed newborns are more likely to develop prolonged hyperbilirubinemia than those fed formula, but the prevalence of prolonged hyperbilirubinemia in a largely white, North American breastfed population is unknown. In this population, we documented the natural history of jaundice and the prevalence of prolonged hyperbilirubinemia, and we evaluated the utility of assessing the cephalocaudal progression of jaundice in office-based practices. METHODS:We measured transcutaneous bilirubin (TcB) levels during the first month in 1044 predominantly breastfed infants $35 weeks of gestation and assigned a cephalocaudal zone score to each infant at the time of the TcB measurement.RESULTS: TcB level was $5 mg/dL in 43% of infants at age 21 6 3 days and 34% were clinically jaundiced. At 28 6 3 days, the TcB was $5 mg/dL in 34% and 21% were jaundiced. There was a strong correlation between the TcB level and the jaundice zone score, but there was a wide range of TcB levels associated with each score.CONCLUSIONS: Practitioners can be reassured that it is normal for 20% to 30% of predominantly breastfed newborns to be jaundiced at age 3 to 4 weeks and for 30% to 40% of these infants to have bilirubin levels $5 mg/dL. The jaundice zone score does not provide an accurate assessment of the bilirubin level, but a score of zero (complete absence of jaundice) suggests that the level is unlikely to be .12.9 mg/dL, whereas a score of $4 usually predicts a level of $10 mg/dL. Pediatrics 2014;134:e340-e345

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“…This negative study marked the end of investigations regarding the effects of aspartic acid on neonatal jaundice. Subsequently, two independent studies that included a total of 34 infants fed Nutramigen demonstrated significantly lower levels of jaundice in the Nutramigen group than in infants fed Enfamil or breast milk (1,2). We suggest that these findings are not related to any effect of aspartic acid on uridine diphosphoglucuronic acid but rather to a differential effect on the enterohepatic circulation of bilirubin due to the inhibition of endogenous (meconium) and exogenous (breast milk) sources of intestinal ␤-glu.…”

Section: Discussionmentioning

confidence: 75%

“…Infants who consumed a casein hydrolysate formula had lower levels of jaundice than infants who received routine (whey or casein predominant) infant formulas (1). This finding was subsequently confirmed in an independent study (2).…”

mentioning

confidence: 68%

A Novel Inhibitor of β-Glucuronidase: l-Aspartic Acid

2001

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Infants who consume casein hydrolysate formula have been shown to have lower neonatal jaundice levels than infants who consume routine formula or breast milk. Because casein hydrolysate has been shown to contain a ␤-glucuronidase inhibitor, one possible mechanism to explain this finding is blockage of the enterohepatic circulation of bilirubin by a component of the formula. The aim of this research was to identify the source of the ␤-glucuronidase inhibition in hydrolyzed casein. A ␤-glucuronidase inhibition assay and measurements of physical and kinetic parameters were used to analyze the components of hydrolyzed casein and infant formulas. Kinetic studies used purified ␤-glucuronidase. The L-aspartic acid in hydrolyzed casein accounts for the majority of the ␤-glucuronidase inhibition present. Kinetic studies indicate a competitive inhibition mechanism. L-Aspartic acid is a newly identified competitive inhibitor of ␤-glucuronidase. NaAC, sodium acetate/acetic acid buffer, pH 4.5 SAB, sodium acetate/acetic acid buffer, pH 5.0 AMP, 100 mM 2-amino-2-methyl-1-propanol buffer containing 0.2% (wt/vol) sodium lauryl sulfate at pH 11.0 NRTU, Nutramigen ready-to-use formula EHC, enzymatically hydrolyzed casein NLFS, Nutramigen lipid-free supernatant PLFS, Phenyl-Free, lipid-free supernatant In 1992, the new finding that all neonatal formulas are not equal in their effect on neonatal jaundice was first reported. Infants who consumed a casein hydrolysate formula had lower levels of jaundice than infants who received routine (whey or casein predominant) infant formulas (1). This finding was subsequently confirmed in an independent study (2). A potential mechanism has been proposed and a causative factor has been identified that might explain this phenomenon. The enterohepatic circulation of bilirubin could be interrupted by a ␤-glu inhibitor present in enzymatically hydrolyzed casein (3). Bilirubin, arising mainly from the degradation of heme, undergoes hepatic conjugation with glucuronic acid and excretion as bilirubin glucuronides via bile into the intestine. Intestinal ␤-glu can cleave the glucuronide linkage to produce unconjugated bilirubin, which can be absorbed by the intestine back into the blood circulation (4). Inhibition of ␤-glu can block this enterohepatic circulation of bilirubin, thus facilitating fecal excretion and lower serum bilirubin concentration (5). Inhibitors of ␤-glu have also been suggested to have anticarcinogenic properties because they will increase clearance of glucuronidated carcinogens (6).Because neonatal jaundice is the most common cause for hospital readmission of neonates (7), any potential new therapeutic considerations are of interest. Identification of any ␤-glu inhibitor that is currently acknowledged to be a safe dietary element would be of considerable appeal. In this paper, data are presented which demonstrate that L-aspartic acid (L-asp) is one component of hydrolyzed casein infant formula that is inhibitory to ␤-glu. L-asp has not previously been identified as a ␤-glu inhibitor...

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The effect of diet on feces and jaundice during the first 3 weeks of life

Cited by 54 publications

References 18 publications

Baby Massage Ameliorates Neonatal Jaundice in Full-Term Newborn Infants

Baby Massage Ameliorates Neonatal Jaundice in Full-Term Newborn Infants

The Natural History of Jaundice in Predominantly Breastfed Infants

A Novel Inhibitor of β-Glucuronidase: l-Aspartic Acid

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