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Nutrition and Jaundice: Hold the Bottle, Keep the Breast

Nutrition and Jaundice: Hold the Bottle, Keep the Breast Gourley et al1 are to be commended for bringing to light so clearly what physicians familiar with breastfeeding have been aware of for many years. That is, in the initial week of life there is no statistically significant difference in levels of physiologic jaundice between infants given standard infant formula and those who are breastfeeding effectively.2 Gourley et al report this finding with surprise—noting that this result must be due to infants who had higher bilirubin levels receiving treatment and being excluded from the study.1 This is likely so. The reason it has come as such a surprise is because the medical community for years has been unable to recognize which infants are breastfeeding effectively—that is, which infants are latched on correctly and effectively transferring milk.3 This is understandable, since traditionally physicians have received little in the way of formal education in the area of breastfeeding.3-5 The American Academy of Pediatrics offers formula supplementation as one of several options in the treatment of hyperbilirubinemia—others include observation of the infant or the initiation of phototherapy without the interruption of breastfeeding.6 The task at hand is to determine which infants actually need formula supplementation, and this number is far fewer than the sponsors of the article would lead the reader to believe. In the case of a healthy breastfeeding newborn, an elevation of the bilirubin level is a signal to evaluate the breastfeeding, looking for correct latch-on, nutritive sucking, signs of milk transfer (from audible swallowing to stool production), and frequency and duration of feedings. One should also investigate the environment—many hospital policies work against the establishment of a good breastfeeding relationship, among them mother and infant separation, the routine use of pacifiers, and supplementary and complementary feedings.7 When supplementation is necessary for the breast-fed infant, expressed breast milk delivered at the breast is the ideal supplement. Breast milk is uniformly recognized as the ideal food for the healthy full-term infant, not only for its nutritional value but also for its immunological benefits.8,9 A further benefit is that expressing milk and providing this expressed milk at the breast both serve to stimulate the breast to greater milk production. It is important to recognize that formula supplementation and especially the interruption of breast-feeding are not required for the treatment of jaundice, even in the event of phototherapy.10 References 1. Gourley GRKreamer BCohnen MKosorok MR Neonatal jaundice and diet. Arch Pediatr Adolesc Med. 1999;153184- 188Google ScholarCrossref 2. Melnikow JBedinghaus M Management of common breastfeeding problems. J Fam Pract. 1994;3956- 64Google Scholar 3. Freed GLClark SJSorenson JRLohr JACefalo ACCurtis P National assessment of physicians' breastfeeding knowledge, attitudes, training, and experience. JAMA. 1995;273472- 476Google ScholarCrossref 4. Freed GL Breast-feeding: time to teach what we preach. JAMA. 1993;269243- 245Google ScholarCrossref 5. Freed GLClark S JCurtis PSorenson JR Breast-feeding education and practice in family medicine. J Fam Pract. 1995;40263- 269Google Scholar 6. American Academy of Pediatrics Provisional Committee for Quality Improvement and Subcomittee on Hyperbilirubinemia, Practice parameter: management of hyperbilirubinemia in the healthy term newborn. Pediatrics. 1994;94558- 565Google Scholar 7. Perez-Escamilla RPollitt ELonnerdal BDewey KG Infant feeding policies in maternity wards and their effect on breastfeeding success: an analytic overview. Am J Public Health. 1994;8489- 97Google ScholarCrossref 8. American Academy of Pediatrics Work Group on Breastfeeding, Breastfeeding and the use of human milk. Pediatrics. 1997;1001035- 1039Google ScholarCrossref 9. Lawrence PB Breast milk best source of nutrition for term and preterm infants. Pediatr Clin North Am. 1994;41925- 941Google Scholar 10. Tan KL Decreased response to phototherapy for neonatal jaundice in breast-fed infants. Arch Pediatr Adolesc Med. 1998;1521187- 1190Google ScholarCrossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Pediatrics & Adolescent Medicine American Medical Association

Nutrition and Jaundice: Hold the Bottle, Keep the Breast

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Publisher
American Medical Association
Copyright
Copyright © 1999 American Medical Association. All Rights Reserved.
ISSN
1072-4710
eISSN
1538-3628
DOI
10.1001/archpedi.153.9.1002
Publisher site
See Article on Publisher Site

Abstract

Gourley et al1 are to be commended for bringing to light so clearly what physicians familiar with breastfeeding have been aware of for many years. That is, in the initial week of life there is no statistically significant difference in levels of physiologic jaundice between infants given standard infant formula and those who are breastfeeding effectively.2 Gourley et al report this finding with surprise—noting that this result must be due to infants who had higher bilirubin levels receiving treatment and being excluded from the study.1 This is likely so. The reason it has come as such a surprise is because the medical community for years has been unable to recognize which infants are breastfeeding effectively—that is, which infants are latched on correctly and effectively transferring milk.3 This is understandable, since traditionally physicians have received little in the way of formal education in the area of breastfeeding.3-5 The American Academy of Pediatrics offers formula supplementation as one of several options in the treatment of hyperbilirubinemia—others include observation of the infant or the initiation of phototherapy without the interruption of breastfeeding.6 The task at hand is to determine which infants actually need formula supplementation, and this number is far fewer than the sponsors of the article would lead the reader to believe. In the case of a healthy breastfeeding newborn, an elevation of the bilirubin level is a signal to evaluate the breastfeeding, looking for correct latch-on, nutritive sucking, signs of milk transfer (from audible swallowing to stool production), and frequency and duration of feedings. One should also investigate the environment—many hospital policies work against the establishment of a good breastfeeding relationship, among them mother and infant separation, the routine use of pacifiers, and supplementary and complementary feedings.7 When supplementation is necessary for the breast-fed infant, expressed breast milk delivered at the breast is the ideal supplement. Breast milk is uniformly recognized as the ideal food for the healthy full-term infant, not only for its nutritional value but also for its immunological benefits.8,9 A further benefit is that expressing milk and providing this expressed milk at the breast both serve to stimulate the breast to greater milk production. It is important to recognize that formula supplementation and especially the interruption of breast-feeding are not required for the treatment of jaundice, even in the event of phototherapy.10 References 1. Gourley GRKreamer BCohnen MKosorok MR Neonatal jaundice and diet. Arch Pediatr Adolesc Med. 1999;153184- 188Google ScholarCrossref 2. Melnikow JBedinghaus M Management of common breastfeeding problems. J Fam Pract. 1994;3956- 64Google Scholar 3. Freed GLClark SJSorenson JRLohr JACefalo ACCurtis P National assessment of physicians' breastfeeding knowledge, attitudes, training, and experience. JAMA. 1995;273472- 476Google ScholarCrossref 4. Freed GL Breast-feeding: time to teach what we preach. JAMA. 1993;269243- 245Google ScholarCrossref 5. Freed GLClark S JCurtis PSorenson JR Breast-feeding education and practice in family medicine. J Fam Pract. 1995;40263- 269Google Scholar 6. American Academy of Pediatrics Provisional Committee for Quality Improvement and Subcomittee on Hyperbilirubinemia, Practice parameter: management of hyperbilirubinemia in the healthy term newborn. Pediatrics. 1994;94558- 565Google Scholar 7. Perez-Escamilla RPollitt ELonnerdal BDewey KG Infant feeding policies in maternity wards and their effect on breastfeeding success: an analytic overview. Am J Public Health. 1994;8489- 97Google ScholarCrossref 8. American Academy of Pediatrics Work Group on Breastfeeding, Breastfeeding and the use of human milk. Pediatrics. 1997;1001035- 1039Google ScholarCrossref 9. Lawrence PB Breast milk best source of nutrition for term and preterm infants. Pediatr Clin North Am. 1994;41925- 941Google Scholar 10. Tan KL Decreased response to phototherapy for neonatal jaundice in breast-fed infants. Arch Pediatr Adolesc Med. 1998;1521187- 1190Google ScholarCrossref

Journal

Archives of Pediatrics & Adolescent MedicineAmerican Medical Association

Published: Sep 1, 1999

Keywords: jaundice,breast,science of nutrition

References