title: Serum bilirubin levels at 72 hours by selected characteristics in breastfed and formula-fed term infants delivered by cesarean section.
abstract: The present multicenter study analysed the relative impact of maternal and infant factors on serum bilirubin levels at 72 +/- 12 h in exclusively breastfed vs formula-fed term infants. End-tidal carbon monoxide levels corrected for ambient air (ETCOc), an index of bilirubin production, were measured in exclusively breastfed (B = 66) or formula-fed (F = 210) term infants at 2-8 h of age. Inclusion criteria included cesarean section to ensure a 3 d hospitalization, birthweight > or = 2,500 g, gestational age >37 wk and absence of any illness. The ETCOc for B infants and F infants did not differ significantly (1.3 +/- 0.7 ppm vs 1.3 +/- 0.8 ppm). The serum bilirubin level at 72 +/- 12 h was significantly higher in B infants than in F infants (8.5 +/- 3.4mg dl(-1) vs 6.7 +/- 3.4mg dl(-1) p < 0.001), as was the percentage weight loss from birthweight. Serum bilirubin levels were significantly higher in infants who were male, who did not have meconium-stained amniotic fluid, and in those whose mothers were insulin-dependent diabetics or hypertensive. There was no difference between groups in the need for phototherapy or exchange transfusion.
  
  
  CONCLUSIONS
  Although higher bilirubin levels were observed in group B at 72 +/- 12 h compared with group F, this finding was not of clinical or therapeutic consequence in this study. The lack of difference in ETCOc between the groups may be a factor of the timing of ETCOc measurement in this study, or may suggest that early increased bilirubin production is not a significant contributor to jaundice observed in exclusively breastfed infants. Key words: bilirubin, breastfeeding, jaundice
authors.affiliation: Division of Neonatal and Developmental Medicine, Stanford University, Palo Alto, California 94304, USA. srhintz@stanford.edu
authors.forename: S R
authors.initials: SR
authors.lastname: Hintz
authors.forename: T D
authors.initials: TD
authors.lastname: Gaylord
authors.forename: W
authors.initials: W
authors.lastname: Oh
authors.forename: A A
authors.initials: AA
authors.lastname: Fanaroff
authors.forename: L
authors.initials: L
authors.lastname: Mele
authors.forename: D K
authors.initials: DK
authors.lastname: Stevenson
authors.forename: F T
authors.initials: FT
authors.lastname: Nichd
mesh_terms: D001663:Bilirubin / Q000097:blood*; D001724:Birth Weight; D001903:Bottle Feeding / Q000009:adverse effects*; D001942:Breast Feeding / Q000009:adverse effects*; D002585:Cesarean Section; D005260:Female; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007567:Jaundice, Neonatal / Q000097:blood; D008297:Male; D011446:Prospective Studies; D013997:Time Factors; D015431:Weight Loss
chemical_list: D001663:Bilirubin