Hyperbilirubinemia in the breast-fed newborn : a controlled trial of four interventions

• Published in: Pediatrics (Evanston) Vol. 91; no. 2; pp. 470 - 473
• Main Authors: MARTINEZ, J. C, MAISELS, M. J, OTHEGUY, L, GARCIA, H, SAVORANI, M, MOGNI, B
• Format: Journal Article
• Language: English
• Published: Elk Grove Village, IL American Academy of Pediatrics 01-02-1993
• Subjects: Analysis of Variance; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Babies; Bilirubin - blood; Biological and medical sciences; Birth Weight; Bottle Feeding - standards; Breast Feeding; Breastfeeding & lactation; Care and treatment; Combined Modality Therapy; Complications and side effects; Delivery, Obstetric - methods; Diseases; Emergency and intensive care: neonates and children. Prematurity. Sudden death; Evaluation; Female; Gestational Age; Humans; Hyperbilirubinemia; Infant, Newborn; Infants (Newborn); Intensive care medicine; Jaundice, Neonatal - blood; Jaundice, Neonatal - etiology; Jaundice, Neonatal - prevention & control; Labor Presentation; Male; Medical research; Medical sciences; Neonatal diseases; Pediatrics; Phototherapy; Phototherapy - methods; Phototherapy - standards; Pregnancy; Treatment Outcome; Human; Hyperbilirubinemia; Newborn; Treatment; Treatment efficiency; Bilirubin; Substitute; Breast feeding; Comparative study; Feeding; Breast milk; Phototherapy
• ISSN: 0031-4005; 1098-4275
• DOI: 10.1542/peds.91.2.470

A controlled clinical trial was conducted to compare the effect of four different interventions on hyperbilirubinemia in 125 full-term breast-fed infants. Of 1685 term infants who met the inclusion criteria, 126 (7.4%) had a serum bilirubin concentration > or = 291 mumol/L (17 mg/dL). When the bilirubin reached this level, babies were assigned at random to one of four interventions: (1) continue breast-feeding and observe; (2) discontinue breast-feeding, substitute formula; (3) discontinue breast-feeding, substitute formula and administer phototherapy; (4) continue breast-feeding, administer phototherapy. The serum bilirubin concentration reached 342 mumol/L (20 mg/dL) in 24% of infants in group 1, 19% in group 2, 3% in group 3, and 14% in group 4. When phototherapy was used, the decline in serum bilirubin was significantly larger and more rapid (compared with no phototherapy). In the majority of breast-fed infants whose serum bilirubin levels reach 291 mumol/L (17 mg/dL) the bilirubin will decline spontaneously and will not reach 342 mumol/L (20 mg/dL). If the infant is significantly jaundiced and a decision is made to intervene, parents can be given a number of options and can make an informed decision regarding which, if any, intervention they prefer.