Neonatal Jaundice and Autism: Precautionary Principle Invocation Overdue

Meta-analyses consistently find a substantial possible association between neonatal jaundice (hyperbilirubinemia) and later autism risk. The obvious question this poses is "what is the source of this risk?" This review explores the complementary roles of jaundice severity and time, racial and geographic disparities, and early infant feeding regime change, and discusses potential implications of these findings. A range of factors appears to increase the risk of autism development following neonatal jaundice, all of which are associated with the "exclusive breastfeeding" paradigm. Severity presents an intuitive risk factor in the context of bilirubin neurotoxicity; jaundice from the modal root cause of insufficient milk intake progresses as that condition persists. Racial and geographic disparities present another intuitive set of risk factors, including a heightened risk of missed diagnosis for darker-skinned neonates and delayed care access in poorer settings. In addition to these intuitive factors, near- or full-term as opposed to preterm status and phototherapy treatment may also heighten risk. These counter-intuitive findings provide additional support for deprivation/starvation as a crucial antecedent or independent variable, and time as a mediator to progression in and subsequent risk from jaundice; heightened medical monitoring and supplementation seem to protect preterms, and phototherapy risks iatrogenesis, having replaced without sufficient safety evidence the prior standard treatment of switching jaundiced, breastfed babies to formula. Critically, jaundice associated with insufficient milk intake due to breastfeeding insufficiencies is fully preventable and trivially treatable with appropriate supplemental milk. Feeding neonates adequately may play an important role in preventing autism and other neurodevelopmental disorders including attention deficit hyperactivity disorder, cerebral palsy, epilepsy, hearing impairment, learning disorders, and mood disorders. Precautionary principle invocation is overdue.