Published online June 1, 2006
PEDIATRICS Vol. 117 No. 6 June 2006, pp. 2317 (doi:10.1542/peds.2006-0321)

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Abuse of Casein Hydrolysate Formulas for Treating Infants With Severe Hyperbilirubinemia

Vinod K. Bhutani, MD
Department of Pediatrics
Division of Neonatal and Developmental Medicine,
Stanford University School of Medicine
Stanford, CA 94305-5208

To the Editor.—

Gourley et al¹ provided preliminary and provocative data to suggest that administration of a specific ß-glucuronidase inhibitor as a concurrent, small-aliquot supplement with breastfeeding would reduce jaundice in healthy infants during the first week after birth. Publication of this study seems to have led many practitioners to prescribe formulas containing casein hydrolysate to infants at risk for severe hyperbilirubinemia. The clinical leap from this small randomized, controlled study to a "therapeutic" practice, from my anecdotal observations and discussions, seems to be increasing. In addition to the potential deleterious effects of using a casein hydrolysate–based formula as a sole nutritional source in lieu of breast milk, the ability of these expensive formulas to predictably reduce bilirubin without interrupting breastfeeding and effectively preventing excessive hyperbilirubinemia are currently unknown.

L-Aspartic acid, as a pharmacologic/nutritional ß-glucuronidase inhibitor, shows promise to slow the rate of bilirubin increase in otherwise healthy breastfeeding infants. The brief data analysis for 17 infants with total serum bilirubin levels >40th percentile, described in the discussion section of the Gourley et al article, seems inconclusive. It would be prudent to know (through an evidence-based study) the magnitude of bilirubin reduction in infants either at risk for severe hyperbilirubinemia (total serum bilirubin levels >75th percentile for age in hours) or those with severe hyperbilirubinemia (total serum bilirubin levels >95th percentile for age in hours). Would the authors concur that resorting to the use of casein hydrolysate formulae is premature (and possibly unsafe) and that prescriptive neonatal administration of L-aspartic acid in infants at risk for severe hyperbilirubinemia requires additional evidence?

REFERENCE

1. Gourley GR, Li Z, Kreamer BL, Kosorok MR. A controlled, randomized, double-blind trial of prophylaxis against jaundice among breastfed newborns. Pediatrics. 2005;116 :385 –391[Abstract/Free Full Text]

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PEDIATRICS (ISSN 1098-4275). ©2006 by the American Academy of Pediatrics

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This Article Extract Full Text (PDF) Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services E-mail this article to a friend Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Add to My File Cabinet Download to citation manager Request Permissions Citing Articles Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Bhutani, V. K. Search for Related Content PubMed PubMed Citation Articles by Bhutani, V. K. Related Collections Premature & Newborn Social Bookmarking                         What's this?