Document Detail


Decreased response to phototherapy for neonatal jaundice in breast-fed infants.
MedLine Citation:
PMID:  9856427     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
K L Tan
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Archives of pediatrics & adolescent medicine     Volume:  152     ISSN:  1072-4710     ISO Abbreviation:  Arch Pediatr Adolesc Med     Publication Date:  1998 Dec 
Date Detail:
Created Date:  1998-12-23     Completed Date:  1998-12-23     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  9422751     Medline TA:  Arch Pediatr Adolesc Med     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  1187-90     Citation Subset:  AIM; IM    
Affiliation:
Department of Neonatology, National University Hospital, Singapore, Republic of Singapore.
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MeSH Terms
Descriptor/Qualifier:
Bilirubin / blood
Breast Feeding*
Hematocrit
Hemoglobins / metabolism
Humans
Infant, Newborn
Jaundice, Neonatal / blood,  therapy*
Phototherapy*
Treatment Outcome
Chemical
Reg. No./Substance:
0/Hemoglobins; 635-65-4/Bilirubin
Comments/Corrections
Comment In:
Arch Pediatr Adolesc Med. 1999 Jun;153(6):655-6   [PMID:  10357313 ]
Arch Pediatr Adolesc Med. 1999 Jun;153(6):657-8   [PMID:  10357315 ]
Arch Pediatr Adolesc Med. 1999 Jun;153(6):656-7   [PMID:  10357314 ]

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