I'm not even done reading the article yet but had to stop and post
this -- I kept thinking, this belongs on LactNet! This study
supports the argument of Dr. Jack and others that hyperbilirubinemia
is mostly a result of inadequate feeding and has little to do with
breastfeeding per se. In fact these researchers found that
breastfeeding is negatively correlated with hyperbilirubinemia.
Interestingly, the use of vacuum extraction during delivery was
positively correlated with hyperbilirubinemia, while cesarean section
was negatively correlated.
Here is an excerpt from the Discussion section:
"The controversy in literature regarding hyperbilirubinemia of
unknown origin is whether breastfeeding increases the incidence of
jaundice in the first days of life. Numerous authors1-4,10,12 have
reported a striking association between breastfeeding and significant
hyperbilirubinemia, but other reports5,11 have not substantiated this
observation. Our data show that a TSB [total serum bilirubin] >12.9
mg/dL (221 µmol/L) is significantly associated with supplementary
feeding and weight loss after birth, whereas breastfeeding is not
correlated with hyperbilirubinemia in the first days of life:
breastfed infants represent only 38.4% of infants with a bilirubin
level >12.9 mg/dL (221 µmol/L). One possible explanation is that in
our hospital, full-term newborn infants start breastfeeding in the
delivery room, they are in a rooming-in setting, and are breastfed on
demand. Infants receive supplementary feeding only when adequate
breastfeeding has failed. In fact, breastfed infants, compared with
newborns given supplementary feeding, had lower weight loss after
birth than did the overall studied population. Moreover, jaundice was
first evident in 42% of infants on the second day and in 55% on the
third day when the percentage of infants with a maximum weight loss
was 52% and 45%, respectively. Multiple regression logistic analysis
shows a statistically positive correlation between TSB >12.9 mg/dL
(221 µmol/L) and weight loss percentage after birth. These data
confirm that the development of neonatal jaundice is not associated
with breastfeeding per se but rather with increased weight loss after
birth subsequent to fasting, suggesting the important role of caloric
intake in the regulation of serum bilirubin. In fact, Osborn et al2
as well as Maisels et al4 found that jaundiced infants did lose more
weight than control infants. A relationship between fasting and
hyperbilirubinemia has been previously reported both in adults and
animals.13,14"
The full text is at
http://www.pediatrics.org/cgi/content/full/107/3/e41 or PEDIATRICS
Vol. 107 No. 3 March 2001, p. e41.
Margaret
LLLL in Longmont, Colorado
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