Earlier Nutrient Fortification of Breastmilk Fed LBW Infants Improves Jaundice Related Outcomes

Abstract

This study aimed to evaluate jaundice outcomes of low-birthweight premature infants commenced on earlier versus later nutrient supplementation (80 mL/kg/day vs. 160 mL/kg/day; total fluid intake, F80 vs. F160). Demographics, feeding regimens, and clinical outcomes data were collected. Infant and maternal characteristics were similar. Earlier nutrient supplementation was associated with multiple improved jaundice outcomes: total (TSBR), unconjugated and conjugated (CSBR) serum bilirubin values (196 ± 46 vs. 228 ± 52, 184 ± 44 vs. 212 ± 50, 12 ± 4 vs. 16 ± 5, respectively, all p < 0.001); phototherapy (39% vs. 64%, p < 0.0001). % CSBR/TSBR ratio was similar between groups. For those on phototherapy, duration and median irradiance were similar. F80 infants experienced reduced: feeding intolerance (26.0% vs. 45.2%, p = 0.007); length of stay (16.0 ± 0.64 vs. 18.8 ± 0.74 days, p = 0.03), maximum weight loss as % birth weight (5% vs. 6%, p = 0.03); decrease in weight Z-score at 10 days (−0.70 ± 0.03 vs. −0.79 ± 0.03, p = 0.01). F80 infants regained birthweight earlier (10.0 ± 0.3 days vs. 11.5 ± 0.3 days, p < 0.0001) and had no differences in adverse clinical outcomes. We speculate that earlier nutrient supplementation improved jaundice outcomes due to enhanced excretion/elimination of bilirubin.

Reducing Procedural Pain and Avoiding Peripheral Intravenous Catheters by Implementing a Feeding Protocol for Late Preterm Infants

“…Hyperbilirubinemia was chosen as a balancing measure due to the impact feeding has on bilirubin excretion. There is a known association between poor enteral intake or dehydration as well as the timing of enteral feedings and the development of hyperbilirubinemia 14-16. The late preterm infant is at a higher risk of developing physiologic jaundice due in part to the degradation of red blood cells and limited ability of the liver to conjugate bilirubin as well as the enterohepatic circulation of unconjugated bilirubin.…”

“…There is a known association between poor enteral intake or dehydration as well as the timing of enteral feedings and the development of hyperbilirubinemia. [14][15][16] The late preterm infant is at a higher risk of developing physiologic jaundice due in part to the degradation of red blood cells and limited ability of the liver to conjugate bilirubin as well as the enterohepatic circulation of unconjugated bilirubin. The American Academy of Pediatrics guidelines and nomograms were followed to determine the threshold for phototherapy.…”

Changes in the integument across the lifespan

“…19 Breast milk is known to contain betaglucuronidase, which in the intestine, decouples glucuronic acid from conjugated bilirubin and allows bilirubin to be reabsorbed by the enterohepatic circulation. 23 Breast milk jaundice first becomes visible on the face and progresses to the trunk and then the extremities around the first weeks of life and may last up to 3 months. 19−21 The jaundice is not actively treated unless the total serum bilirubin level of the infant is greater than 20mg/dL, when phototherapy may be employed.…”

Breast milk jaundice affects breastfeeding: From the perspective of intestinal flora and SCFAs-GPR41/43

“…Newman et al ( 20 ) first reported that breastmilk was a contributing factor to the development of neonatal jaundice. Breastmilk contains the substance beta-glucuronidase, which, in the intestine, decouples glucuronic acid from conjugated bilirubin and allows bilirubin to be reabsorbed by the enterohepatic circulation ( 21 ). In addition, bilirubin undergoes selective metabolism by UDP-glucuronosyltransferase (UGT) 1A1, that UGT1A1 gene mutation is closely related to BMJ ( 22 , 23 ).…”