PEDIATRICS Vol. 91 No. 2 February 1993, pp. 470-473
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Hyperbilirubinemia in the Breast-Fed Newborn: A Controlled Trial of Four Interventions

Jorge C. Martinez MD1, Lydia Otheguy MD1, Horacio Garcia MD1, Monica Savorani MD1, Beatriz Mogni MD1, Jorge C. Martinez Jr 1, and M. Jeffrey Maisels MB, B.Ch2

1 From the Hospital Materno Infantil "R. Sarda," Buenos Aires, Argentina
2 From the Department of Pediatrics, William Beaumont Hospital, Royal Oak, MI

A controlled clinical trial was conducted to compare the effect of four different interventions on hyperbilirubinemia in 125 full-term breast-fed infants. Of 1685 term infants who met the inclusion criteria, 126 (7.4%) had a serum bilirubin concentration ge291 µmol/L (17 mg/dL). When the bilirubin reached this level, babies were assigned at random to one of four interventions: (1) continue breast-feeding and observe; (2) discontinue breast-feeding, substitute formula; (3) discontinue breast-feeding, substitute formula and administer phototherapy; (4) continue breast-feeding, administer phototherapy. The serum bilirubin concentration reached 342 µmol/L (20 mg/dL) in 24% of infants in group 1, 19% in group 2, 3% in group 3, and 14% in group 4. When phototherapy was used, the decline in serum bilirubin was significantly larger and more rapid (compared with no phototherapy). In the majority of breast-fed infants whose serum bilirubin levels reach 291 µmol/L (17 mg/dL) the bilirubin will decline spontaneously and will not reach 342 µmol/L (20 mg/dL). If the infant is significantly jaundiced and a decision is made to intervene, parents can be given a number of options and can make an informed decision regarding which, if any, intervention they prefer.

Key Words: breast-feeding • newborn • hyperbilirubinemia • phototherapy

Submitted on August 14, 1992
Accepted on October 20, 1992




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