Related Experiment Videos
Decreased response to phototherapy for neonatal jaundice in breast-fed infants
1Department of Neonatology, National University Hospital, Singapore, Republic of Singapore.
Insights
Phototherapy effectively treats nonhemolytic hyperbilirubinemia in infants. Adding formula to breast milk for exclusively breast-fed infants can improve phototherapy efficacy and reduce treatment duration.
Area of Science:
- Neonatal Medicine
- Pediatric Gastroenterology
Background:
- Nonhemolytic hyperbilirubinemia is common in newborns.
- Phototherapy is a standard treatment for elevated bilirubin levels.
Purpose of the Study:
- To compare the efficacy of phototherapy for nonhemolytic hyperbilirubinemia in exclusively breast-fed, exclusively formula-fed, and mixed-fed infants.
Main Methods:
- A prospective study involving 163 full-term healthy infants with nonhemolytic hyperbilirubinemia.
- Infants were divided into three feeding groups: formula-fed, breast-fed, and mixed-fed.
- Conventional phototherapy was administered until bilirubin levels decreased below a specified threshold.
Main Results:
- Exclusively breast-fed infants required longer phototherapy exposure and showed a slower rate of bilirubin decrease compared to formula-fed and mixed-fed infants.
- Weight loss was significantly greater in exclusively breast-fed infants.
- Post-exposure bilirubin rebound was comparable, but moderate jaundice was more prolonged in exclusively breast-fed infants.
Conclusions:
- Phototherapy efficacy is adequate but slower in exclusively breast-fed infants.
- Supplementing breast milk with formula can enhance phototherapy effectiveness and shorten treatment duration without discontinuing breastfeeding.
Objective:
To evaluate the efficacy of phototherapy for nonhemolytic hyperbilirubinemia in breast-fed and formula-fed infants and infants receiving formula and breast milk.
Design:
Prospective study.
Setting:
Nursery for healthy infants.
Method:
Full-term healthy infants with nonhemolytic hyperbilirubinemia (bilirubin concentration, >255 micromol/L [14.9 mg/dL] or 222 micromol/L [13.0 mg/dL] at ages younger than 48 hours) were treated with conventional phototherapy by using daylight fluorescent lamps. Three groups of infants were studied: group 1, formula-fed infants; group 2, breast-fed infants; and group 3, infants receiving formula and breast milk. All patterns of feeding started at birth. Phototherapy was terminated only when bilirubin concentrations had decreased to less than 185 micromol/L (10.8 mg/dL); the minimum exposure period was 24 hours.
Results:
A total of 163 infants were studied: group 1, 79; group 2, 34; and group 3, 50. The age at the start of exposure was comparable in all groups. The mean+/-SD weight loss as a percentage of birth weight was as follows: group 1, 2.8%+/-5.0%; group 2, 6.1%+/-3.4%; and group 3, 3.2%+/-2.6%. The duration of exposure to phototherapy was as follows: group 1, 54.1+/-20.8 hours; group 2, 64.6+/-25.1 hours; and group 3, 54.9+/-21.5 hours; the 24-hour rate of decrease in the bilirubin concentration was as follows: group 1, 18.6%+/-11.7%; group 2, 17.1%+/-9.6%; and group 3, 22.9%+/-9.4%. The overall rate of decrease in the bilirubin concentration for the duration of exposure to phototherapy was as follows: group 1, 0.8%+/-0.3% per hour; group 2, 0.6%+/-0.3% per hour; and group 3, 0.8%+/-0.3% per hour. Weight loss at the start of phototherapy was significantly greater in group 2 compared with group 1 (P<.001) and group 3 (P<.001), although the hemoglobin and hematocrit values were comparable. The duration of exposure to phototherapy was not significantly different in the 3 groups (P=.06); however, the duration of exposure of group 2 infants was 10 hours more than that of the other 2 groups. The 24-hour rate of decrease in the bilirubin concentration in group 3 was significantly better than that of group 2 (P = .007) and group 3 (P = .02); the rates of decrease for groups 2 and 3 were similar (P = .52). The overall rate of decrease in the bilirubin concentration during the duration of exposure to phototherapy in group 2 was significantly less than that of group 1 (P = .002) and group 3 (P<.001); the rates for groups 1 and 3 were similar (P = .35). The postexposure rebound bilirubin concentrations were comparable in all groups during the first 2 days; however, the duration of moderate jaundice in group 2 was more prolonged.
Conclusions:
The response to phototherapy of group 2 infants was significantly slower than that of group 3 and group 1 infants; this response was still of adequate efficacy. The addition of formula to the feedings for totally breast-fed infants, without suspension of breast-feeding, would enhance the efficacy of phototherapy and reduce exposure time.