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The Impact of Breast-Feeding on Early Neonatal Jaundice

January 2008

Authors:

Yi-Ying Lin

Taipei City Hospital

Po-Nien Tsao

National Taiwan University Hospital

Chien-Yi Chen

National Taiwan University Hospital

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Objective: The purpose of this study is to evaluate the impact of breast-feeding promotion on the incidence of hyper-bilirubinemia, on peak bilirubin level and on mean days of hospitalization. Study Design: The study population consisted of 1273 healthy full-term newborns born before and after the Baby Friendly Hospital Initiative Program was launched in July 2000. The relationship between breast-feeding and the inci-dence of hyperbilirubinemia (bilirubin level >12.9 mg/dL), body weight(BW) loss ratio, mean hospital days, bilirubin level on the third or fourth day, peak bilirubin level and mean days of phototherapy were analyzed. Results: The rate of breast-feeding during hospitalization was increased from 92.18% to 97.15% after implementation of the Baby Friendly Hospital Initiative Program. The incidence of hyperbilirubinemia among newborns born after the Program also increased from 10.88% to 23.77%. There was a significant association between monthly rates of breast-feeding and the incidence of hyperbilirubinemia, BW loss ratio, the bilirubin level on the third or fourth day, the peak bilirubin level, the mean hospital days, the mean days of phototherapy, as well as the frequencies of urination and defecation. Maximum BW loss day after birth, BW loss ratio and breast-feeding were the most significant factors related to hyperbilirubinemia. Conclusions: After the Baby Friendly Hospital Initiative Program was launched, the incidence of hyperbilirubinemia increased. This result may be due to increased weight loss caused by improper breast-feeding. Increased weight loss and breast-feeding were found to be associated with an increase in the incidence of hyperbilirubinemia, the bilirubin level on the third or fourth day, the mean days of hospitalization and phototherapy. Although breast-feeding remains the single best choice for infants and parents, jaundice and prolonged hospitalization related to improper breast-feeding should be kept in mind by medical personnel. (Clinical Neonatology 2008;15:31-35) Neonatal jaundice remains the most common problem in full-term infants in the nursery, especially in Asia. Prior studies have shown that the incidence of hyper-bilirubinemia in full-term newborns in the first week of life ranges from 4.8% to 15.5% [1-4]. However, there is still much controversy over the role of breast-feeding in the incidence of hyperbilirubinemia and its effect on peak bilirubin level [1-8]. After increased promotion of breast-feeding in Taiwan, the incidence of neonatal hy-perbilirubinemia during the first week of life seemed to be increasing. The purpose of this study is to evaluate the impact of breast-feeding promotion on the incidence of neonatal hyperbilirubinemia, on peak bilirubin level and on mean days of hospitalization.

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YY Lin, PN Tsao, WS Hsieh, et al

31 Clinical Neonatology 2008 Vol. 15 No.1

The Impact of Breast-Feeding on Early Neonatal

Jaundice

Yi-Ying Lin1,2,3, Po-Nien Tsao1, Wu-Shiun Hsieh1, Chien-Yi Chen1, Hung-Chieh Chou1

Objective: The purpose of this study is to evaluate the impact of breast-feeding promotion on the incidence of hyper-

bilirubinemia, on peak bilirubin level and on mean days of hospitalization.

Study Design: The study population consisted of 1273 healthy full-term newborns born before and after the Baby

Friendly Hospital Initiative Program was launched in July 2000. The relationship between breast-feeding and the inci-

dence of hyperbilirubinemia (bilirubin level >12.9 mg/dL), body weight(BW) loss ratio, mean hospital days, bilirubin

level on the third or fourth day, peak bilirubin level and mean days of phototherapy were analyzed.

Results: The rate of breast-feeding during hospitalization was increased from 92.18% to 97.15% after implementation

of the Baby Friendly Hospital Initiative Program. The incidence of hyperbilirubinemia among newborns born after the

Program also increased from 10.88% to 23.77%. There was a significant association between monthly rates of

breast-feeding and the incidence of hyperbilirubinemia, BW loss ratio, the bilirubin level on the third or fourth day, the

peak bilirubin level, the mean hospital days, the mean days of phototherapy, as well as the frequencies of urination and

defecation. Maximum BW loss day after birth, BW loss ratio and breast-feeding were the most significant factors related

to hyperbilirubinemia.

Conclusions: After the Baby Friendly Hospital Initiative Program was launched, the incidence of hyperbilirubinemia

increased. This result may be due to increased weight loss caused by improper breast-feeding. Increased weight loss

and breast-feeding were found to be associated with an increase in the incidence of hyperbilirubinemia, the bilirubin

level on the third or fourth day, the mean days of hospitalization and phototherapy. Although breast-feeding remains the

single best choice for infants and parents, jaundice and prolonged hospitalization related to improper breast-feeding

should be kept in mind by medical personnel. (Clinical Neonatology 2008;15:31-35)

Key Words: bilirubin, breast-feeding, hyperbilirubinemia, jaundice, Baby Friendly Hospital Initiative Program

Neonatal jaundice remains the most common problem in

full-term infants in the nursery, especially in Asia. Prior

studies have shown that the incidence of hyper-

bilirubinemia in full-term newborns in the first week of

life ranges from 4.8% to 15.5% [1-4]. However, there is

still much controversy over the role of breast-feeding in

the incidence of hyperbilirubinemia and its effect on

peak bilirubin level [1-8]. After increased promotion of

breast-feeding in Taiwan, the incidence of neonatal hy-

perbilirubinemia during the first week of life seemed to

be increasing. The purpose of this study is to evaluate the

impact of breast-feeding promotion on the incidence of

neonatal hyperbilirubinemia, on peak bilirubin level and

on mean days of hospitalization.

Materials And Methods

In Taiwan, the Baby Friendly Hospital Initiative Program

was launched in July 2000. Mothers are encouraged to

nurse their babies when they were hungry and were told

not to limit the frequency or length of nursing. Supple-

mentation with infant formula was given only when the

babies cried even after breast-feeding or at the request of

the family.

A total of 3107 neonates were born in our institution

before (from July 1 to December 31, 1999) and after

(from July 1 to December 31, 2001) the Baby Friendly

Hospital Initiative Program was initiated. Babies with a

positive Coombs’ test, an elevated reticulocyte count,

1Departments of Pediatrics, National Taiwan University

Hospital and National Taiwan University College of

Medicine, Taipei 2Departments of Pediatrics, Taipei Hos-

pital, Department of Health 3Departments of Pediatrics,

Kinmen Hospital, Department of Health, Taiwan

Received: October 5, 2007

Accepted: April 24, 2008

Reprint Requests to: Dr. Hung-Chieh Chou, Depart

ment

of Pediatrics, National Taiwan University Hospital,

No.7,

Chung-Shan South Road, Taipei, 100, Taiwan

Breast-Feeding and Neonatal Jaundice

Clinical Neonatology 2008 Vol. 15 No.1

cephalohematoma, subgaleal hemorrhage, ecchymoses, a

major anomaly, jaundice occurring within the first day of

life, infection and maternal diabetes were all excluded. A

total of 1273 healthy, full-term newborns were enrolled

under the following criteria: uncomplicated vaginal de-

livery, birth weight >2500 gm, gestational age >37 weeks

and Apgar score >7 at 1 minute.

The clinical and laboratory data, including body

weight (BW), gestational age (GA), Apgar score, mater-

nal age, type and amount of feeding, bilirubin level, as

well as the frequencies of urination and defecation, were

extracted from the baby’s charts. All infants were

weighted naked each morning before feeding. Heel-stick

blood was obtained in the morning of the third or fourth

hospital day or at indicated times for microbilirubin level,

hematocrit and newborn screening. Microbilirubin level

was measured by direct spectrophotometry of the serum

in a microhematocrit tube (Leica Unistat bilirubinometer,

Wetzlar, Germany). If the microbilirubin level was <12.9

mg/dL, the babies were discharged and followed up at

our outpatient department. Otherwise, the babies were

kept in the nursery for observation until the micro-

bilirubin level falls below 12.9 mg/dL. According to our

neonatal care guidelines, the babies will be admitted to

the neonatal observation room (NOR) and receive pho-

totherapy if the microbilirubin level was >12 mg/dL on

the second day of life or >15 mg/dL on or after the third

day of life. When the bilirubin level was >17 mg/dL, the

following additional investigations were performed:

blood smear for RBC morphology, complete blood cell

count, reticulocyte count, Coombs’ test and blood typing.

The relationship between the monthly rate of

breast-feeding and the incidence of hyperbilirubinemia

(bilirubin level >12.9 mg/dL), BW loss ratio, mean hos-

pital days, the bilirubin level on the third or fourth day,

the peak bilirubin level and the mean days of photother-

apy were analyzed by Pearson’s correlation coefficient.

Statistical analyses were performed using the independ-

ent samples t-test for continuous variables; otherwise the

Chi-Square test was used for categorical variables. To

quantify the relationship between clinical variables and

hyperbilirubinemia we used logistic regression analysis.

A p value below 0.05 was considered to be statistically

significant.

Results

The clinical and laboratory characteristics of the study

population are shown in Table 1. After implementation of

the Baby Friendly Hospital Initiative Program, the rate of

breast-feeding increased from 92.18% to 97.15% and the

incidence of hyperbilirubinemia increased from 10.88%

to 23.77%. In addition, the BW loss ratio, the bilirubin

level on the third or fourth day, the peak bilirubin level

and the mean days of hospitalization and phototherapy

all increased significantly after breast-feeding promotion

started (all p<0.001). The frequencies of urination and

defecation on the first two days of life also decreased

significantly (p<0.001).

Table 1. Clinical and Laboratory Characteristics Before

and After the Start of the Baby Friendly Hos-

pital Initiative Program

Before

(n=726)

After

(n=547)

Male/Female 352/374 272/275 0.661

GA (weeks) 39.2

1.1 39.2 ± 1.1

0.841

Birth weight

(grams)

3238.1

346.2

3233.5

333.5

0.814

Maximum BW loss

day after birth

2.7 ± 0.8 2.7 ± 0.8 0.095

Maximum BW loss

ratio (%)

4.9 ± 1.7 6.0 ± 2.2 < 0.001

Maternal age (y/o) 30.9 ± 3.9 31.3 ± 4.1

0.041

Apgar score (5) 9 (8-10)+ 9 (9-9)+ 0.318

Bilirubin on 3rd or

4th day (mg/dL)

9.64

2.36 11.06 ± 2.58

< 0.001

Peak bilirubin day 3.4 ± 0.6 3.5 ± 0.6 0.073

Peak bilirubin

(mg/dL)

9.77

2.52 11.22 ± 2.74

< 0.001

Bilirubin >12.9

mg/dL baby num-

bers

79 130 < 0.001

Mean hospital days 3.8 ± 1.0 4.1 ± 1.2 < 0.001

Urination frequency

on 2nd day

6.0 ± 1.9 4.7 ± 1.8 < 0.001

Urination frequency

on 3rd day

6.8 ± 2.0 5.5 ± 1.9 < 0.001

Defecation fre-

quency on 2nd day

4.6 ± 2.4 3.8 ± 2.1 < 0.001

Defecation fre-

quency on 3rd day

4.7 ± 2.5 4.1 ± 2.1 < 0.001

Mean phototherapy

days

0.1 ± 0.6 0.3 ±0.8 < 0.001

* Data presented as mean ± SD

+ Presented as median (minimum-maximum)

YY Lin, PN Tsao, WS Hsieh, et al

33 Clinical Neonatology 2008 Vol. 15 No.1

The relationships between the clinical variables and

hyperbilirubinemia are shown in Table 2. In the group

with hyperbilirubinemia, the maximum BW loss day

after birth and BW loss ratio increased significantly

(p<0.001). The breast-feeding method also showed a

significant relationship with hyperbilirubinemia (p＝

0.001).

Table 2. Relationship Between Hyperbilirubinemia and

Clinical Characteristics

Peak Bilirubin

Level (mg/dL)

<12.9

(n=1064)

>12.9

(n=209)

Male/Female 515/549 109/100 0.321

GA (weeks) 39.2 ± 1.1 39.1 ± 1.1 0.813

Birth weight

(grams)

3233.1

339.6

3251.8

346.1

0.468

Maximum BW

loss day after birth

2.6 ± 0.7 3.0 ± 0.8 < 0.001

±±

Maximum BW

loss ratio (%)

5.2 ± 1.8 6.2 ± 2.7 0.001

±±

Maternal age (y/o)

31.1 ± 4.0 31.1 ± 3.8 0.887

Number of

Breast-fed babies

82 38 0.001

±±

Apgar score (5) 9 (9-10)+ 9 (8-9)+ 0.999

±±

Urination fre-

quency on 2nd day

5.5 ± 2.0 5.1 ± 1.8 0.748

±±

Urination fre-

quency on 3rd day

6.3 ± 2.1 6.0 ± 2.1 0.883

±±

Defecation fre-

quency on 2nd day

4.3 ± 2.3 4.0 ± 2.0 0.247

±±

Defecation fre-

quency on 3rd day

4.5 ± 2.4 4.4 ± 2.1 0.472

* Data presented as mean ± SD

+ Presented as median (minimum-maximum)

± Logistic regression

Significant positive correlations were noted between

the rate of breast-feeding and the incidence of hyper-

bilirubinemia (r = 0.810; p = 0.001), the BW loss ratio (r

= 0.872; p < 0.001), the bilirubin level on the third or

fourth day (r = 0.768; p = 0.004), the peak bilirubin level

(r = 0.765; p = 0.004), mean hospital days (r = 0.791; p =

0.002) and mean days of phototherapy (r = 0.822; p =

0.001) (Table 3). Significant negative correlations were

also noted between the rate of breast-feeding and the

frequencies of urination and defecation on the second

and third day of life (Table 3). A significant relationship

between maximal BW loss ratio and the incidence of

hyperbilirubinemia was also documented (r = 0.944; p <

0.001) (Figure 1).

Fig

FigFig

Fig.

. 1.

1. 1.

1. Relationship between maximum BW loss ratio

and the incidence of hyperbilirubinemia

(r = 0.944; p < 0.001)

In our study, 3.99% and 8.78% of infants had

bilirubin level >15 mg/dL before and after the Baby

Friendly Hospital Initiative Program, respectively, indi-

cating a correlation with the rate of breast-feeding (r =

0.560; p = 0.058).

Discussion

The incidence of hyperbilirubinemia in full-term new-

borns in the first week of life has been found to vary

from 4.8% to 15.5% in previous reports [1-4]. The inci-

dence of hyperbilirubinemia in our study increased from

10.88% to 23.77% after the launching of the breast-

feeding promotion program. Numerous reports have in-

dicated a striking association between breast-feeding and

hyperbilirubinemia [3,4,6,7,9-13], but this does not seem

to be universal [1,2,4,8,14]. Our study showed a strong

correlation between neonatal jaundice and breast-feed-

ing.

Several interpretations can be made of the associa-

tion of breast-feeding and neonatal hyperbilirubinemia.

The most likely mechanisms include dehydration, caloric

deprivation and enhancement of enterohepatic circulation.

Previous studies had documented that breast-fed infants

lose more weight in the first few days of life than for-

mula-fed infants and that there is an association between

BW loss and hyperbilirubinemia [7,12,15]. Our study

also showed that infants born after the Baby Friendly

Hospital Initiative Program was started to lose more BW,

indicating a striking positive association between maxi-

mum BW loss ratio and rate of breast-feeding.

0 5 10 1 5 20 2 5 30 35

The Incidence of Hype rbi lirubine mia (%)

7.0

6.5

6.0

5.5

5.0

4.5

Maximum BW Loss Ratio (%)

Breast-Feeding and Neonatal Jaundice

Clinical Neonatology 2008 Vol. 15 No.1

The effect of caloric deprivation on serum bilirubin

was first noted by Gilbert and Hershi in 1906 [16]. Later,

Barrett [17] and Felsher et al [18] have shown that fast-

ing causes a significant elevation of serum bilirubin lev-

els in both normal adults and patients with hepatic dis-

ease. After nursing and milk flow are well established,

breast-fed infants have been shown to receive fewer

calories than bottle-fed peers in the first three to five

days after birth [19]. Gartner et al documented that the

enhanced enterohepatic circulation of bilirubin is a major

factor in the pathogenesis of fasting-induced hyper-

bilirubinemia [20]. De Carvalho et al found that

breast-fed infants excrete significantly less bilirubin in

their stools and pass less stool than bottle-fed infants in

the first three days of life [21]. In this study, we also

found that BW loss ratio increased significantly after the

breast-feeding promotion was started and that there was

a significant negative correlation between frequencies of

urination and defecation and monthly rate of breast-

feeding.

In accord with previous results, early neonatal jaun-

dice was found to be associated with an increase BW

loss ratio and breast-feeding in this study. The reason for

the greater BW loss may be inadequate breast-feeding.

Proper breast-feeding is necessary to prompt a good sup-

ply of breast milk and inappropriate breast-feeding can

cause poor breast milk production and dehydration.

Skin-to-skin contact between mother and infant immedi-

ately following birth, rooming-in, anticipatory guidance

and avoidance of formula supplementation and pacifiers

are recommended to establish and maintain successful

breast-feeding [22]. Although the rate of breast-feeding

was increased in our nursery, the incidence of hyper-

bilirubinemia also increased. This may be due to an in-

appropriate sucking posture and inadequate feeding fre-

quency. Thus our efforts must be directed towards more

frequent visits to the lactating mother and closer moni-

toring of the breast-fed newborns. The evaluation should

include general health, body weight, positioning posture

during breast-feeding, jaundice and elimination fre-

quency.

We also found that the mean days of hospitalization

and phototherapy were significantly increased after the

promotion of breast-feeding. Prolonged hospitalization

maybe due to the elevated incidence of hyperbilirubine-

mia, in which case infants are kept in the nursery for

close observation or admitted to the NOR for photother-

apy. Prolonged phototherapy may be due to less effective

phototherapy when the caloric and fluid intake levels are

low [23]. Prolonged hospitalization and phototherapy

also increase medical costs, in addition to causing de-

spair and anxiety among the parents. Hence, all health-

care providers should be familiar with inappropriate

breast-feeding induced jaundice and the treatment of

breast-feeding jaundice. Moreover, we must increase our

efforts to establish and maintain successful breast-feed-

ing, including person-to-person support of the lactating

mother, skin contact between mother and infant immedi-

ately following birth, rooming-in, more frequent visiting

of the lactating mother and closer monitoring of the

breast-fed newborns; these activities will reduce the in-

cidence of hyperbilirubinemia causing by inappropriate

breast-feeding.

Conclusions

After Baby Friendly Hospital Initiative Program was

launched, the incidence of hyperbilirubinemia increased.

This change may be due to increased weight loss caused

by improper breast-feeding. Increased weight loss and

breast-feeding were associated with the increase in the

incidence of hyperbilirubinemia, the bilirubin level on

the third or fourth day as well as the mean days of hospi-

talization and phototherapy. Although breast-feeding

remains the single best choice for infants and parents,

jaundice and prolonged hospitalization related to im-

proper breast-feeding should be kept in mind by medical

personnel.

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Effect of Early Supplemental Formula Intervention on Body Weight and Hyperbilirubinemia in Neonates During 72 h After Birth

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Jul 2020

Mohammed Talib Abed

Jaundice is the greatest common situation that needs medicinal care in neonates, which present as yellow coloration of the skin and sclera related to accumulation of unconjugated bilirubin which was considered a neurotoxic to cause brain death (Kernicterus). The Aim of this study to identify the effect of successful breast feeding on neonatal hyperbillirubinemia. Material & method: Design a descriptive design was conducted through a period of study .The sample & setting: were taken accidentally from (250) mothers who had children under one year from practicing breast feeding from Babel maternity and pediatric hospital. Data collection were collected through structured interview and application of the questionnaire with mothers regarding their early achievement of breast fed their jaundiced .Self-administered instrument which takes about 30 minutes. Data analysis: data analyzed the equal number of mother's age were (43.2%) who were aged (26-31) ,with majority (47.2%) of the sample were not educated , therefore that (92.0%) were not working. The researchers recommend educational booklets construction concerning the ten steps of successful breast feeding.

Mother's Knowledge of Initiative Breast Feeding in Relation to Neonatal Jaundice

Article

Full-text available

Jul 2020

The study on the effect of gender on serum bilirubin concentration in infants with neonatal hyperbilirubunemia

Article

Full-text available

Apr 2013
IJPBS

Krishna Veni Desai Venkata

The study was undertaken to observe the gender based variation in serum bilirubin levels in neonatal Hyperbilirubinemia. A total of seventy nine healthy full term infants (50 females and 29 males) in age group of 1-7 days, who presented with visible nonhemolytic hyperbilirubinemia were analyzed. There was no significant difference in maternal age, gestational age, birth weight and perinatal age in between male and female infants. Total bilirubin levels were high both in female and male infants and there was no significant difference between them. But the direct bilirubin levels were significantly high in female infants compared to male infants during the neonatal period.

Knowledge, attitude and techniques of breastfeeding among Nigerian mothers from a semi-urban community

Article

Full-text available

Dec 2013
BMC Res Notes

Mothers' poor knowledge and negative attitude towards breastfeeding may influence practices and constitute barriers to optimizing the benefits of the baby-friendly initiative. This study assessed breastfeeding knowledge, attitude and techniques of postures, positioning, hold practice and latch-on among Nigerian mothers from a Semi-Urban community. Three hundred and eighty three consenting lactating mothers who have breastfed for 6 months and up to two years volunteered for this cross-sectional survey, yielding a response rate of 95.7%. A self-administered questionnaire that sought information on maternal socio-demographic variables, knowledge, attitudes and breastfeeding techniques of mothers was employed. Based on cumulative breastfeeding knowledge and attitude scores, 71.3% of the respondents had good knowledge while 54.0% had positive attitude. Seventy one point three percent practiced advisable breastfeeding posture. Sitting on a chair to breastfeed was common (62.4%); and comfort of mother/baby (60.8%) and convenience (29.5%) were the main reasons for adopting breastfeeding positions. Cross-cradle hold (80.4%), football hold technique (13.3%), breast-to-baby (18.0%) and baby-to-breast latch-on (41.3%) were the common breastfeeding techniques. A majority of the respondents (75.7%) agreed that neck flexion, slight back flexion, arm support with pillow and foot rest was essential during breastfeeding. There was no significant association between breastfeeding posture practice and each of cumulative breastfeeding knowledge score levels (X2 = 0.044; p = 0.834) and attitude score levels (X2 = 0.700; p = 0.403). Nigerian mothers demonstrated good knowledge and positive attitude towards breastfeeding. Most of the mothers practiced advisable breastfeeding postures, preferred sitting on a chair to breastfeed and utilized cross-cradle hold and baby-to-breast latch-on.

PENGARUH INISIASI MENYUSUI DINI TERHADAP PERUBAHAN KADAR BILIRUBIN PADA BAYI BARU LAHIR DI RUANG PERINATOLOGI RSUD AL IHSAN BANDUNG PROVINSI JAWA BARAT

Article

Aug 2019

Hiperbilirubinemia merupakan salah satu fenomena klinis yang paling sering ditemukan pada bayi baru lahir. Sekitar 25 â€“ 50% bayi baru lahir menderita ikterus, untuk mencegah terjadinya ikterus maka dilakukan IMDÂ Â dengan harapan bayi segera mendapatkan kolostrum. Tujuan penelitian ini adalah mengetahui Pengaruh Inisiasi Menyusu Dini terhadap Perubahan Kadar Bilirubin pada Bayi Baru Lahir di Ruang Perinatologi RSUD Al ihsan. Penelitian ini adalah Eksperimen dengan rancangan Posttest Only design Group dengan menggunakan teknik Purposive sampling pada 30 responden.gambaran pengaruh inisiasi menyusu dini terhadap perubahan kadar bilirubin pada bayi baru lahir bahwa hasil uji normalitas menggunakan uji Shapiro-Wilk (untuk sampel di bawah 50 orang) menunjukkan kadar bilirubin kelompok bayi IMD dan tidak IMD memiliki nilai p sebesar 0,729 dan 0,781. Nilai p > á¾³=0,050 artinya data kadar bilirubin kelompok bayi IMD dan tidak IMD berdistribusi normal, analisis statistik yang digunakan adalah Independent t Test bahwa nilai thitung sebesar 3,356 dengan ttabel pada ï¡ = 0.05 dan db = n â€“ 2 = 30 â€“ 2 = 28 sebesar 2,048. Dengan demikian nilai p > á¾³= 0.05. Disimpulkan bahwa terdapat Pengaruh Inisiasi Menyusu Dini terhadap Perubahan Kadar Bilirubin pada Bayi Baru Lahir di Ruang Perinatologi RSUD Al ihsan Bandung. Saran perlu dilakukan Tindakan Inisiasi Menyusu Dini ( IMD )Â pada satu jam pertama kelahiran sehingga dapat meningkatkan mutu asuhan Keperawat Pada Bayi Bary Lahir.Â Kata Kunci : Inisiasi menyusu dini, kadar bilirubin.

874-9445/23 Send Orders for Reprints to reprints@benthamscience.net The Open Public Health Journal CROSS-SECTIONAL STUDY Current Knowledge and Attitude to Exclusive Breastfeeding Practice among Lactating Mothers Visiting a Health Facility in Lagos State, Nigeria Sokan-adeaga et al

Article

Full-text available

Jan 2023

Background: Information about maternal knowledge and attitude toward exclusive breastfeeding (EBF) practice is consequential to the actualization of the goals of the baby-friendly initiative and Millennium Development Goals (MDGs) 4 and 5. This paper assessed the current knowledge and attitude of EBF practices among nursing mothers attending a health facility in Lagos, Nigeria. Methods: The study employed a descriptive cross-sectional descriptive design. One hundred and twenty (120) nursing mothers attending the Isheri Olofin Primary Health Centre (IOPHC) and currently breastfeeding children between 0-24 months were interviewed. A pre-tested questionnaire that elicits information on maternal socio-demographic characteristics, child index, 24-point knowledge scale, 30-point attitude scale, and 12-point practice scale of EBF was employed. Data was analysed using descriptive, Chi-square, and adjusted odd ratios (aORs) generated from a logistic regression model. Results: About 89.2% of the respondents demonstrated good knowledge, while 81.7% depicted a positive attitude. All respondents (100%) had heard about EBF. About 86.7% believed that EBF is only adequate in the first six months of a newborn baby. Respondents with good knowledge of EBF were 3 folds more likely to have good EBF practice than those with poor knowledge (aOR=3.07, 95% confidence interval [CI]: 1.74, 9.52), while those with a positive attitude towards EBF were twice as likely to have good EBF practice than those with a negative attitude (aOR=2.17, 95% CI: 1.16, 5.73). Conclusion: Respondents had good knowledge and a positive attitude towards EBF practice. The study also affirmed a strong relationship between maternal EBF knowledge and attitude and current practice among the respondents. Highlights: Respondents exhibited good knowledge and a positive attitude toward exclusive breastfeeding (EBF) practice. Respondents initiated breastfeeding within 24hrs of birth and fed their infants with colostrum. Current practices have a significant relationship with maternal EBF knowledge and maternal attitude.

Current Knowledge and Attitude to Exclusive Breastfeeding Practice among Lactating Mothers Visiting a Health Facility in Lagos State, Nigeria

Article

Full-text available

Nov 2023
Open Publ Health J

Epidemiology of Neonatal Hyperbilirubinemia

Article

Full-text available

May 1985

Interview and record review data from 12,023 singleton deliveries were analyzed to determine the relationships between neonatal hyperbilirubinemia (10 mg/dL or greater) and maternal characteristics. Confounding variables were controlled by multiple logistic regression analysis. There was a statistically significant positive relationship between hyperbilirubinemia and low birth weight, Oriental race, premature rupture of membranes, breast-feeding, neonatal infection, use of the "pill" at time of conception, instrumental delivery, and history of first trimester bleeding. Maternal smoking and black race were negatively related to hyperbilirubinemia and statistically significant. In this study, other previously suspected etiologic factors such as epidural anesthesia, parity, use of oxytocin in labor, and white race were not associated with hyperbilirubinemia.

Sur les variations de la cholemie physiologique

Article

Bilirubinemia and fasting.

Article

Oct 1970

P V Barrett

The effect of a 44- to 48-hour fast on the serum bilirubin concentration was studied in five normal subjects and in five patients with hepatic dysfunction. The total serum bilirubin (TSB) concentration increased progressively during the fasting period in all patients; expressed as a percent of the control value, it averaged 240% for the normal subjects and 194% for the patients with hepatic dysfunction at the completion of the fast (P >0.05). One normal subject fasted for 110 hours; the TSB increased to 326% of the control value at 63 hours and then fell to approximately twice the control value for the remainder of the fast. A diurnal rhythm of the TSB was demonstrated in one patient, but was suppressed by nocturnal feedings. It was concluded that an increase in bilirubin concentration occurs as a function of fasting.

Factors affecting neonatal jaundice

Article

Mar 1979
Arch Dis Child

Plasma bilirubin was estimated on 690 term infants on about the 6th day of life. Perinatal factors were recorded and the results analysed. Hyperbilirubinaemia was defined as a level greater than 205 micromol/1 (12 mg/100 ml) and this was present in 20% of cases. Three factors--epidural analgesia, breast feeding, and poor weight recovery--showed highly significant associations with jaundice. The relative importance of these is discussed and compared with recent reports. Induction of labour, for reasons other than postmaturity, and a gestational age less than 39 weeks showed a slightly increased incidence of jaundice. There was no correlation with other factors tested including oxytocic drug administration. Despite the high incidence (20%) of hyperbilirubinaemia, only 2.5% infants needed treatment and none required exchange transfusion. Radical changes in obstetric management or infant feeding are not indicated.

Are breast-fed babies still getting a raw deal in hospital?

Article

Nov 1979

After preliminary validation of test weighing under ward conditions the fluid intake and weight gain of 39 breast-fed and 25 artificially fed infants were compared. All were fed every four hours for six feeds a day, and the breast-fed infants received dextrose supplements only. The average intake and weight gain of the breast-fed group was significantly less than that of the group fed artificially.When cows'-milk supplements are withheld from breast-fed infants a four-hourly regimen provides insufficient stimulus to lactation for their needs in the first week of life. If more than lip service is to be paid to the mother who desires to breast-feed in hospital, early and more frequent feeding should be practised.

Jaundice in the healthy newborn infant: A new approach to an old problem

Article

May 1988

We measured the serum bilirubin concentrations in 2,416 consecutive infants admitted to our well baby nursery. The maximal serum bilirubin concentration exceeded 12.9 mg/dL (221 mumol/L) in 147 infants (6.1%), and these infants were compared with 147 randomly selected control infants with maximal serum bilirubin levels less than or equal to 12.9 mg/dL. A serum bilirubin concentration greater than 12.9 mg/dL was associated strongly with breast-feeding (P = .0000) and percentage of weight loss after birth (P = .0001), as well as with maternal diabetes, oriental race, decreased gestational age, male sex, bruising, and induction of labor with oxytocin. Risk ratios and the risk of jaundice were calculated for hypothetical infants in the presence and absence of these variables. These calculations show that, in certain infants, "nonphysiologic" jaundice is likely to develop and its presence in such infants might not require laboratory investigations. In others, a modest degree of hyperbilirubinemia could be cause for concern. An awareness of these factors and their potential contribution to serum bilirubin levels permits a more rational approach to the action levels used for the investigation of jaundice in the newborn. We need a new definition of physiologic jaundice.

Breast Milk Jaundice in the Newborn: A Real Entity

Article

Jul 1986

A. Patrick Schneider

I have reviewed clinical trials that provide data relative to the comparative rates, means, or odds ratio of jaundiced normal breast-fed newborns vs jaundiced normal formula-fed newborns. A pooled analysis of 12 studies revealed moderate jaundice (serum bilirubin level, ≥12 mg/dL) in 514 of 3,997 breast-fed vs 172 of 4,255 formula-fed newborns. An analysis of six of these 12 studies demonstrated severe jaundice (serum bilirubin level, ≥15 mg/dL) in 54 of 2,655 breast-fed vs ten of 3,002 formula-fed newborns. Eleven of 13 studies found breast-fed newborns to have a higher mean serum bilirubin level. One study of 12,023 newborns found a significant (odds ratio, 1.80) relationship between breast-feeding and jaundice of the newborn. In conclusion, breast-feeding is one common cause of jaundice in normal newborns in the first week of life and beyond. (JAMA 1986;255:3270-3274)

Normal Serum Bilirubin Levels in the Newborn and the Effect of Breast-Feeding

Article

Dec 1986

We measured the serum bilirubin concentrations in 2,416 consecutive infants admitted to our well-baby nursery. The maximum serum bilirubin concentration exceeded 12.9 mg/dL (221 mumol/L) in 147 infants (6.1%), and these infants were compared with 147 randomly selected control infants with maximum serum bilirubin levels less than or equal to 12.9 mg/dL. In 66 infants (44.9%), we identified an apparent cause for the jaundice, but in 81 (55%), no cause was found. Of infants for whom no cause for hyperbilirubinemia was found, 82.7% were breast-fed v 46.9% in the control group (P less than .0001). Breast-feeding was significantly associated with hyperbilirubinemia, even in the first three days of life. The 95th percentile for bottle-fed infants is a serum bilirubin level of 11.4 mg/dL v 14.5 mg/dL for the breast-fed population, and the 97th percentiles are 12.4 and 14.8 mg/dL, respectively. Of the formula-fed infants, 2.24% had serum bilirubin levels greater than 12.9 mg/dL v 8.97% of breast-fed infants (P less than .000001). When compared with previous large studies, the incidence of "readily visible" jaundice (serum bilirubin level greater than 8 mg/dL) appears to be increasing. The dramatic increase in breast-feeding in the United States in the last 25 years may explain this observation. There is a strong association between breast-feeding and jaundice in the healthy newborn infant. Investigations for the cause of hyperbilirubinemia in healthy breast-fed infants may not be indicated unless the serum bilirubin level exceeds approximately 15 mg/dL, whereas in the bottle-fed infant, such investigations may be indicated if the serum bilirubin exceeds approximately 12 mg/dL.(ABSTRACT TRUNCATED AT 250 WORDS)

Metabolic aspects of phototherapy

Article

Mar 1985

The influence of fluid and caloric intake on neonatal jaundice and efficacy of phototherapy was evaluated. Results indicate that overall, higher fluid and caloric intake were associated with lower daily mean serum bilirubin level in both phototherapy-treated and control infants. This association was stronger with increased calories than with increased fluids, and primarily was dependent on oral caloric intake. The inverse correlation between oral caloric intake and serum bilirubin level was more marked in infants in the lowest birth group (< 2,000 g) in which phototherapy was used to prevent hyperbilirubinemia. The caloric effect was less evident in infants in the higher birth weight groups and when phototherapy was used to treat established hyperbilirubinemia.

Incidence of Hyperbilirubinemia in Breast- vs. Formula-fed Infants

Article

Mar 1985

A retrospective study of 233 consecutively born full-term infants was performed to determine the effect of several variables on the development of hyperbilirubinemia. Thirty-five (15%) of the infants developed peak bilirubin levels greater than 12 mg/dl in the first week of life. Step wise multiple regression analysis revealed that breast-feeding was the most predictive of a group of eight variables for the development of hyperbilirubinemia greater than 12 mg/dl. The correlation between type of feeding and hyperbilirubinemia was significant (p < 0.02). None of the other factors evaluated was significantly associated with hyperbilirubinemia. Breast-fed infants also were found to have a significantly higher incidence of hyperbilirubinemia greater than 15 mg/dl; 12 of 101 (12%) infants compared with 2 of 117 (2%) formula-fed infants (p < 0.002). This group of infants accounted for the increased incidence of hyperbilirubinemia greater than 12 mg/dl in breast-fed infants. There was no significant correlation between weight loss and development of hyperbilirubinemia in the breast-fed infants.

The Impact of Breast-Feeding on Early Neonatal Jaundice

Abstract

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Vitamin D Supplementation as Adjuvant with Phototherapy Is Beneficial in Neonatal Jaundice

Researchable Issues in Neonatal Jaundice

Frequency of hypocalcemia in jaundiced term neonates under phototherapy

To study the effectiveness of cord blood Albumin as a predictor of neonatal jaundice