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Breast feeding and jaundice in the first week of life
Insights
This study found that interrupting breastfeeding temporarily and providing formula for newborns with jaundice can effectively treat hyperbilirubinemia at home, reducing costly phototherapy readmissions.
Area of Science:
- Neonatal care
- Pediatrics
- Public health
Background:
- Neonatal hyperbilirubinemia is common in breast-fed infants.
- Inadequate nursing may contribute to jaundice, not breastfeeding itself.
- Phototherapy readmissions present a significant healthcare cost.
Purpose of the Study:
- To reduce phototherapy readmissions for neonatal hyperbilirubinemia.
- To evaluate the efficacy of home treatment versus hospital readmission.
- To assess the impact of lactation induction policies.
Main Methods:
- Temporary interruption of breastfeeding (24-48 hours) and formula supplementation for infants nearing treatment levels.
- Comparison of home treatment outcomes with hospital readmission rates.
- Analysis of breastfeeding incidence and healthcare costs.
Main Results:
- 81 out of 87 infants were successfully treated at home, significantly reducing readmissions.
- No difference in breastfeeding rates at two weeks between groups.
- Average cost per patient was $126 for home treatment versus $1,440 for readmission.
Conclusions:
- Supervised home treatment with counseling is an effective alternative to phototherapy readmission.
- Temporary breastfeeding interruption and formula feeding can manage neonatal jaundice.
- Lactation induction policies did not reduce jaundice incidence in this cohort.
Abstract:
Infants who most commonly receive treatment for neonatal hyperbilirubinemia are breast-fed babies in whom no cause for the jaundice can be determined. Hyperbilirubinemia in these newborns may not be caused by the breast feeding as such, but rather by inadequate nursing. This paper reports attempts to decrease readmissions for phototherapy at the UCLA Medical Center by inducing earlier and more functional lactation in the entire nursery population and by formula feeding infants whose bilirubins approached recommended treatment levels. Nursing was interrupted for 24 to 48 hours in 87 newborns; six still required readmission, while 81 were successfully treated at home. At the two-week well-baby visit, no differences in the incidence of breast feeding were found when comparing nonjaundiced breast-fed babies with infants who were taken off the breast or who were readmitted for phototherapy. Differences in the cost of care were significant with an average cost per patient of $126 for those treated at home compared with $1,440 for those readmitted. Policies designed to induce earlier lactation did nothing to decrease the incidence of exaggerated jaundice in the study's breast-fed population. It was concluded that supervised setting with careful counseling and follow-up, can provide an effective alternative to readmission and phototherapy in the treatment of jaundice.