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The natural history of jaundice in predominantly breastfed infants
M Jeffrey Maisels1, Sarah Clune2, Kimberlee Coleman2
1Department of Pediatrics, Oakland University William Beaumont School of Medicine, Beaumont Children's Hospital, Royal Oak, Michigan jmaisels@beaumont.edu.
Insights
It is common for 20-30% of breastfed newborns to show jaundice at 3-4 weeks old, with 30-40% having bilirubin levels of at least 5 mg/dL. Jaundice assessment in newborns requires careful monitoring.
Area of Science:
- Neonatal Medicine
- Pediatrics
- Public Health
Background:
- Prolonged hyperbilirubinemia is more common in breastfed infants.
- Prevalence data for prolonged hyperbilirubinemia in predominantly white, North American breastfed infants is lacking.
- Understanding jaundice natural history in this population is crucial.
Purpose of the Study:
- To document the natural history of jaundice in predominantly breastfed newborns.
- To determine the prevalence of prolonged hyperbilirubinemia in this population.
- To evaluate the utility of cephalocaudal jaundice progression assessment.
Main Methods:
- Transcutaneous bilirubin (TcB) levels were measured in 1044 predominantly breastfed infants (≥35 weeks gestation) during the first month.
- A cephalocaudal zone score was assigned to each infant at the time of TcB measurement.
- Data analysis focused on TcB levels and clinical jaundice at 21 and 28 days.
Main Results:
- At 21 ± 3 days, 43% of infants had TcB levels ≥5 mg/dL, and 34% were clinically jaundiced.
- At 28 ± 3 days, 34% had TcB levels ≥5 mg/dL, and 21% were clinically jaundiced.
- A strong correlation existed between TcB levels and jaundice zone scores, but with considerable variability.
Conclusions:
- It is normal for 20-30% of predominantly breastfed newborns to be jaundiced at 3-4 weeks, with 30-40% having bilirubin levels ≥5 mg/dL.
- The jaundice zone score is not a precise predictor of bilirubin levels.
- A jaundice zone score of zero suggests bilirubin levels are unlikely to exceed 12.9 mg/dL, while a score of ≥4 often indicates levels ≥10 mg/dL.
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 ± 3 days and 34% were clinically jaundiced. At 28 ± 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.
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