Decreased response to phototherapy for neonatal jaundice in breast-fed infants

Abstract

Objective: To evaluate the efficacy of phototherapy for nonhemolytic hyperbilirubinemia in breast-fed and formula-fed infants and infants receiving formula and breast milk. Design: Prospective study. Selling: Nursery for healthy infants. Method: Full-term healthy infants with nonhemolytic hyperbilirubinemia (bilirubin concentration, >255 μmol/L [14.9 mg/dL] or 222 μmo//L [13.0 mg/dL] at ages younger than 48 hours) were treated with conventional phototherapy by using daylight fluorescent lamps. Three groups of infants were studied: group 1, formula-fed infants; group 2, breast-fed infants; and group 3, infants receiving formula and breast milk. All patterns of feeding started at birth. Phototherapy was terminated only when bilirubin concentrations had decreased to less than 185 μmol/L (10.8 mg/dL); the minimum exposure period was 24 hours. Results: A total of 163 infants were studied: group 1, 79; group 2, 34; and group 3, 50. The age at the start of exposure was comparable in all groups. The mean ± SD weight loss as a percentage of birth weight was as follows: group 1, 2.8% ± 5.0%; group 2, 6.1% ± 3.4%; and group 3, 3.2% ± 2.6%. The duration of exposure to phototherapy was as follows: group 1, 54.1 ± 20.8 hours; group 2, 64.6 ± 25.1 hours; and group 3, 54.9 ± 21.5 hours; the 24-hour rate of decrease in the bilirubin concentration was as follows: group 1, 18.6% ± 11.7%; group 2, 17.1% ± 9.6%; and group 3, 22.9% ± 9.4%. The overall rate of decrease in the bilirubin concentration for the duration of exposure to phototherapy was as follows: group 1, 0.8% ± 0.3% per hour; group 2, 0.6% ± 0.3% per hour; and group 3, 0.8% ± 0.3% per hour. Weight loss at the start of phototherapy was significantly greater in group 2 compared with group 1 (P