Epidemiology

Bilirubin normal by six days in most breastfed newborns

Last Updated: 2011-09-08 15:50:21 -0400 (Reuters Health)

NEW YORK (Reuters Health) - High bilirubin in a healthy, exclusively breastfed term newborn will usually normalize by the time the baby is six days old, a new paper reports.

"These data are useful for clinicians who educate parents about the natural history of bilirubinemia and the importance of appropriate breastfeeding in term newborns," said Dr. Cecilia Maria Draque and colleagues from the Universidade Federal de Sao Paulo in Brazil in an August 28th online paper in Pediatrics.

The authors believe they're the first to study jaundice "in neonates who were exclusively breastfed and whose weight changes were monitored for up to 12 days of life."

During their study they tracked weight and bilirubin levels in 223 neonates, all appropriate-for-gestational-age, rooming-in for at least 48 hours, and exclusively breastfed.

In each infant the research team measured forehead transcutaneous bilirubin and body weight on days 1, 2, 3, 4, 5, 6, 8, 10 and 12 after birth, for a total of 2,007 bilirubin measurements. Using the residual mean square for each day, the researchers constructed 25th, 50th, 75th, 90th, and 95th percentile curves.

The greatest average weight loss, of 4.7%, occurred on the second or third day of life, and most infants were back to their birth weight when they were five days old.

On day one, the 50th percentile bilirubin level was 4.8 mg/dL, while the 95th percentile level was 8.2 mg/dL.

The 50th percentile level peaked on the third and fourth days of life, at 5.6 mg/dL. The 95th percentile peak of 12.2 mg/dL came on the fourth day of life.

By day six, the 50th percentile level had returned to 4.8 mg/dL. The 95th percentile level declined more slowly, reaching 8.5 mg/dL on day 12.

Forty-one newborns (18%) still had bilirubin levels above 6 mg/dL on day 12. For this group, on average, bilirubin levels fell below 6 mg/dL by day 21 (range, 15 to 42 days). Three babies (1.3%) were still jaundiced at 30 days, with an average bilirubin level of 8.8 mg/dL.

"The lowest total bilirubin levels found in the present study could be associated with appropriate breastfeeding practices, as demonstrated by the maximum weight loss of 4.7% between the second and third days of life and by the recovery to the birth weight at five days in most newborns," the researchers noted.

They concluded, "Initiation of breastfeeding in the first hour of life, followed by nursing 10 to 12 times per day in the first week, with no other supplementation of water or other foods, together with appropriate breastfeeding techniques that ensure effective provision of milk to the neonate, (will) minimize weight loss to <7%, and keep bilirubin levels low."

SOURCE: http://bit.ly/noMKMl

Pediatrics 2011;128:e565-e571.