PEDIATRICS Vol. 78 No. 5 November 1986, pp. 837-843
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Normal Serum Bilirubin Levels in the Newborn and the Effect of Breast-Feeding

M. Jeffrey Maisels MB, BCh1 and Kathleen Gifford RNC1

1 From the Division of Newborn Medicine, Department of Pediatrics, The Milton S. Hershey Medical Center, The Pennsylvania State University, Hershey

We measured the serum bilirubin concentrations in 2,416 consecutive infants admitted to our well-baby nursery. The maximum serum bilirubin concentration exceeded 12.9 mg/dL (221 µmol/L) in 147 infants (6.1%), and these infants were compared with 147 randomly selected control infants with maximum serum bilirubin levels le12.9 mg/dL. In 66 infants (44.9%), we identified an apparent cause for the jaundice, but in 81 (55%), no cause was found. Of infants for whom no cause for hyperbilirubinemia was found, 82.7% were breast-fed v 46.9% in the control group (P < .0001). Breast-feeding was significantly associated with hyperbilirubinemia, even in the first three days of life. The 95th percentile for bottle-fed infants is a serum bilirubin level of 11.4 mg/dL v 14.5 mg/dL for the breast-fed population, and the 97th percentiles are 12.4 and 14.8 mg/dL, respectively. Of the formula-fed infants, 2.24% had serum bilirubin levels >12.9 mg/dL v 8.97% of breast-fed infants (P < .000001). When compared with previous large studies, the incidence of "readily visibl" jundice (serum bilirubin level >8 mg/dL) appears to be increasing. The dramatic increase in breast-feeding in the United States in the last 25 years may explain this observation. There is a strong association between breast-feeding and jaundice in the healthy newborn infant. Investigations for the cause of hyperbilirubinemia in healthy breast-fed infants may not be indicated unless the serum bilirubin level exceeds approximately 15 mg/dL, whereas in the bottle-fed infant, such investigations may be indicated if the serum bilirubin exceeds approximately 12 mg/dL. If phototherapy is ever indicated in healthy term infants, the overwhelming majority of such infants are likely to be breast-fed; if breast-feeding is, indeed, the cause of such jaundice, a more appropriate approach to hyperbilirubinemia in the breast-fed infant might be to treat the cause (by temporary cessation of nursing) rather than (using phototherapy to treat) the effect.

Key Words: bilirubin • jaundice • newborn infant • breast-feeding

Submitted on January 27, 1986
Accepted on March 4, 1986




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