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(Pediatrics in Review Neo Reviews. 2000;1:e25-e31.)
© 2000 American Academy of Pediatrics

Breastfeeding, Diet, and Neonatal Hyperbilirubinemia

^*

^* Department of Pediatrics and Waisman Center on Mental Retardation and Human Development, University of Wisconsin School of Medicine, Madison, WI.

OBJECTIVES

After completing this article, readers should be able to:

1. Compare and contrast the incidence of hyperbilirubinemia between breastfed and formula-fed infants throughout the neonatal period and its relationship to early hospital discharge.
   
2. Describe possible reasons for the occurrence of hyperbilirubinemia in breastfed infants.
   
3. Compare and contrast the incidence of hyperbilirubinemia related to different infant formulas.
   

Introduction

Among the many factors related to neonatal hyperbilirubinemia is the composition of an affected infant’s diet. In 1879, Frerichs suggested that "bad nursing" could "exercise a powerful influence" on neonatal hyperbilirubinemia. Much has been learned since this suggestion was made.

Breastfeeding and Hyperbilirubinemia

     EPIDEMIOLOGY
Many investigations have documented that the consumption of human milk is related to neonatal hyperbilirubinemia, including one review of 12 studies involving more than 8,000 infants in the first week of life and controlled for factors such as hemolysis to enable comparison of dietary effects alone. Moderate hyperbilirubinemia (total serum bilirubin [TSB], 205 mcmol/L [12 mg/dL]) was present in 12.9% of the breastfed infants and 4% of the formula-fed infants (P<0.00001). Severe hyperbilirubinemia (TSB, 256 mcmol/L [15 mg/dL]) was present in 2% of the breastfed infants and 0.3% of the formula-fed infants (P<0.00001). Breastfed infants have higher serum bilirubin levels on each of the first 5 days of life, and this hyperbilirubinemia can persist for weeks to months. The association between feedings of human milk and neonatal hyperbilirubinemia has been reported in preterm infants fed banked human milk or mixtures of human milk and formula and among various races.

More recent studies of otherwise healthy newborns have used noninvasive transcutaneous devices to assess hyperbilirubinemia daily (Figs. 1 and 2 ). These studies agree with earlier conclusions that otherwise healthy infants exclusively fed human milk will have higher levels of hyperbilirubinemia than infants who consume formula. The difference begins to become significant . . . [Full Text of this Article]

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