I'm not a researcher BUT it says that vaginal delivery is a risk to hyerbilirunia.  When you read the article, it is the vaginal delivery with augmentation or other medications which accelerate the risk.  Headlines, eh?  Grrrrrr


Vaginal Delivery Increases Risk of Hyperbilirubinemia in Breast-Fed Infants



NEW YORK (Reuters Health) May 30 - Vaginal delivery, as well as a genetic polymorphism and G6PD deficiency, are associated with increased risk for hyperbilirubinemia in exclusively breast-fed infants, a Taiwanese team reports.

The prevalence was considerably higher than the 5%-12% typically seen in Caucasian infants, the authors note. "It suggests that demographic and genetic factors may be involved in the development of hyperbilirubinemia in breast-fed neonates."

Writing in the Journal of Pediatrics online May 19, Dr. Yen-Hsuan Ni, with the National Taiwan University Children's Hospital in Taipei, and colleagues note that breast-fed babies have higher bilirubin levels than infants who are formula-fed, and that incidences of severe hyperbilirubinemia and kernicterus are high in Asian infants.

To investigate risk factors for hyperbilirubinemia, the team conducted a prospective study of 252 term infants who were exclusively breast fed. Hyperbilirubinemia, defined as a bilirubin level of 15.0 mg/dL or higher at 3 days of age, was documented in 59 (23.4%) of the infants.

On multivariate analysis, the researchers found three significant risk factors for hyperbilirubinemia: deficiency of glucose-6-phosphate dehydrogenase (G6PD) with an odds ratio of 12.24 (p=0.04), presence of a variant nucleotide 211 in the gene for UGT1A1 (UDP-glucuronosyltransferase 1A1), with an OR of 2.48 (p=0.006), and vaginal delivery (OR 3.55; p<0.001).

Discussing the latter finding, Dr. Ni and colleagues write: "Vaginal delivery may be associated with oxytocin usage, vacuum extraction, and cephalohematoma (known risk factors for hyperbilirubinemia). Oxytocin exposure, a risk factor for hyperbilirubinemia was first recognized >25 years ago. Oxytocin may have some direct effect on neonatal bilirubin metabolism."

"In contrast, cesarean delivery may protect against jaundice. A possible explanation is that infants who are delivered by cesarean delivery tended to receive supplementation with infant formula, which would not cause hyperbilirubinemia as often as breast milk," they add.

However, they note, the mechanism underlying the development of hyperbilirubinemia associated with breastfeeding "is not clearly understood." Their findings suggest that breastfeeding "may act as an external factor for certain variant genotypes predisposing to the development of hyperbilirubinemia."

SOURCE: http://bit.ly/mJ4QR9 

J Pediatr 2011.




Steph MacD
6 Nations, Ontario Canada

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