Related Experiment Videos
Hyperbilirubinemia in the breast-fed newborn: a controlled trial of four interventions
J C Martinez1, M J Maisels, L Otheguy
1Hospital Materno Infantil R. Sarda, Buenos Aires, Argentina.
Insights
For breastfed infants with hyperbilirubinemia, phototherapy significantly speeds bilirubin reduction. Most infants with high bilirubin levels will see spontaneous decline without intervention.
Area of Science:
- Neonatal Medicine
- Pediatrics
- Clinical Trials
Background:
- Hyperbilirubinemia is common in term breast-fed infants.
- A significant percentage of infants reach serum bilirubin levels requiring intervention.
- Effective management strategies are crucial for infant health.
Purpose of the Study:
- To compare four interventions for managing hyperbilirubinemia in full-term breast-fed infants.
- To evaluate the efficacy of phototherapy and formula substitution.
- To inform clinical decision-making and parental choice.
Main Methods:
- Controlled clinical trial involving 125 term breast-fed infants.
- Infants randomly assigned to four groups: observation, formula substitution, formula substitution with phototherapy, or continued breast-feeding with phototherapy.
- Serum bilirubin levels monitored, with a threshold of 291 mumol/L (17 mg/dL) for intervention.
Main Results:
- Phototherapy significantly accelerated and increased the decline in serum bilirubin.
- Only 3% of infants receiving phototherapy and formula substitution reached 342 mumol/L (20 mg/dL).
- In contrast, 24% of infants with observation alone reached this higher level.
Conclusions:
- Phototherapy is highly effective in reducing high bilirubin levels in breast-fed infants.
- While many infants experience spontaneous bilirubin decline, phototherapy offers a rapid and effective intervention.
- Informed parental choice regarding interventions is important when managing infant jaundice.
Abstract:
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.