Reuters Health Information (2005-08-03): Prophylaxis cuts jaundice risk, doesn't affect breastfeeding
Prophylaxis cuts jaundice risk, doesn't affect breastfeeding
Last Updated: 2005-08-03 13:45:10 -0400 (Reuters Health)
NEW YORK (Reuters Health) - Giving breast-fed infants a
few ounces of a beta-glucuronidase inhibitor daily for the first week
of life reduces their risk of developing jaundice, according to a new
report in the August issue of Pediatrics.
The findings suggest it could be possible for infants to reap
breastfeeding's benefits without the accompanying higher risk of
"It was very well tolerated by the babies and the parents," Dr.
Glenn R. Gourley of Oregon Health and Science University in Portland,
the study's lead author, told Reuters Health. "In general, the study
was seen as a very positive thing, and it didn't interfere with
breastfeeding in any way."
Previous research has shown that infant formula is protective
against jaundice, particularly formulas that contain beta-glucuronidase
inhibitors. Breast milk is rich in this enzyme, which, in utero, helps
to clear bilirubin from the fetal circulation via the placenta. But
after birth, the enzyme promotes jaundice by slowing its clearance from
Dr. Gourley's team determined whether giving breast-fed infants
small amounts of beta-glucuronidase inhibitors would reduce their risk
of jaundice. Sixty-four breastfed infants were randomized to four
groups: controls, who received no additional supplementation; or three
groups given six 5-mL doses of L-aspartic acid, enzymatically
hydrolyzed casein (EHC) or whey/casein daily. Whey/casein does not
contain beta-glucuronidase inhibitors.
At day 4 after birth, all the infants given prophylaxis had lower
transcutaneous bilirubin levels than the control infants. Bilirubin
levels in babies given L-aspartic acid were a mean 75.8% lower, while
they were 69.6% and 69.2% lower for those given EHC or whey/casein,
respectively. Infants given L-aspartic acid also excreted significantly
more bile in the stool.
Because whey/casein does not contain beta-glucuronidase, it must
prevent jaundice by some other mechanism, Dr. Gourley noted. "We don't
really have an explanation for that."
There was no difference among the four groups in terms of weight
gain, amount of milk per feeding, age at first supplementation or
duration of breastfeeding.
When the researchers looked specifically at 17 infants with
bilirubin levels above the low-risk zone within 48 hours of birth, they
found those given EHC or L-aspartic acid showed a faster decline to the
low-risk zone than those who were not given glucuronidase inhibitors.
"To be able to see the finding on such a small number is encouraging
that it would be worth doing further studies," Dr. Gourley said.
The next step, he added, will be to investigate whether certain
prophylactic combinations could be more effective and whether it might
be possible to give prophylaxis for a shorter period of time. "The less
you'd have to do it, the nicer it would be for parents," he said.