title: Hyperbilirubinemia in the breast-fed newborn: a controlled trial of four interventions.
abstract: 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 > or = 291 mumol/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 mumol/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 mumol/L (17 mg/dL) the bilirubin will decline spontaneously and will not reach 342 mumol/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.
authors.affiliation: Hospital Materno Infantil R. Sarda, Buenos Aires, Argentina.
authors.forename: J C
authors.initials: JC
authors.lastname: Martinez
authors.forename: M J
authors.initials: MJ
authors.lastname: Maisels
authors.forename: L
authors.initials: L
authors.lastname: Otheguy
authors.forename: H
authors.initials: H
authors.lastname: Garcia
authors.forename: M
authors.initials: M
authors.lastname: Savorani
authors.forename: B
authors.initials: B
authors.lastname: Mogni
authors.forename: J C
authors.initials: JC
authors.lastname: Martinez
mesh_terms: D000704:Analysis of Variance; D001663:Bilirubin / Q000097:blood; D001724:Birth Weight; D001903:Bottle Feeding / Q000592:standards*; D001942:Breast Feeding; D003131:Combined Modality Therapy; D036861:Delivery, Obstetric / Q000379:methods; D005260:Female; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007567:Jaundice, Neonatal / Q000097:blood / Q000209:etiology / Q000517:prevention & control*; D007746:Labor Presentation; D008297:Male; D010789:Phototherapy / Q000379:methods / Q000592:standards*; D011247:Pregnancy; D016896:Treatment Outcome
chemical_list: D001663:Bilirubin