The African-American neonate at risk for extreme hyperbilirubinemia: a better management strategy is needed

Golden, William

doi:10.1038/jp.2017.1

Cited by 4 publications

(4 citation statements)

References 19 publications

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“…In a previous review, Wilde [ 26 ] found a lower threshold of concern is appropriate for jaundice in the context of prematurity [ 142 ], low birth weight, systemic infection such as sepsis, birth trauma [ 143 ], C-section, male gender [ 144 ], Asian race due to increased incidence of UGT1A1 or SLCOs polymorphisms [ 145 - 147 ], African, Sephardic Jewish, Greek, Turkish, Chinese, and Italian races due to increased risk of glucose-6-phosphate dehydrogenase (G-6-PD) deficiency [ 148 ], and darker skin due to melanin reducing visible skin yellowing [ 149 ]. While a lower threshold of concern is thus appropriate for African/Black, Asian, and other darker-skinned infants, in practice, a higher threshold of concern may instead sometimes still prevail, because it used to be widely believed that Black babies were at lower risk for jaundice and associated harms [ 148 , 150 ]. In addition, many of these heightened-risk categories tend to overlap (e.g., preterm and Black) [ 151 ], and we do not know how they interact in terms of potentially magnifying risks of harm associated with neonatal jaundice.…”

Section: Reviewmentioning

confidence: 99%

Neonatal Jaundice and Autism: Precautionary Principle Invocation Overdue

Wilde¹

2022

Cureus

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Meta-analyses consistently find a substantial possible association between neonatal jaundice (hyperbilirubinemia) and later autism risk. The obvious question this poses is "what is the source of this risk?" This review explores the complementary roles of jaundice severity and time, racial and geographic disparities, and early infant feeding regime change, and discusses potential implications of these findings. A range of factors appears to increase the risk of autism development following neonatal jaundice, all of which are associated with the "exclusive breastfeeding" paradigm. Severity presents an intuitive risk factor in the context of bilirubin neurotoxicity; jaundice from the modal root cause of insufficient milk intake progresses as that condition persists. Racial and geographic disparities present another intuitive set of risk factors, including a heightened risk of missed diagnosis for darker-skinned neonates and delayed care access in poorer settings. In addition to these intuitive factors, near- or full-term as opposed to preterm status and phototherapy treatment may also heighten risk. These counter-intuitive findings provide additional support for deprivation/starvation as a crucial antecedent or independent variable, and time as a mediator to progression in and subsequent risk from jaundice; heightened medical monitoring and supplementation seem to protect preterms, and phototherapy risks iatrogenesis, having replaced without sufficient safety evidence the prior standard treatment of switching jaundiced, breastfed babies to formula. Critically, jaundice associated with insufficient milk intake due to breastfeeding insufficiencies is fully preventable and trivially treatable with appropriate supplemental milk. Feeding neonates adequately may play an important role in preventing autism and other neurodevelopmental disorders including attention deficit hyperactivity disorder, cerebral palsy, epilepsy, hearing impairment, learning disorders, and mood disorders. Precautionary principle invocation is overdue.

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Section: Reviewmentioning

confidence: 99%

Neonatal Jaundice and Autism: Precautionary Principle Invocation Overdue

Wilde¹

2022

Cureus

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“…This limitation applies equally to stationary percent thresholds based on mean weight loss, which fail to account for dispersion, and to comparisons of a neonate's weight loss to that of a reference cohort, estimating percentiles of weight loss as a function of time from birth, like the free website Newt (newbornweight.org) does using a cohort of around 160,000 California neonates [157]. For jaundice, a lower threshold of concern is appropriate in the context of: prematurity [158]; low birthweight; systemic infection such as sepsis; birth trauma [113]; C-section; male gender [159]; Asian race due to increased incidence of UGT1A1 [160][161][162]; African, Sephardic Jewish, Greek, Turkish, Chinese, and Italian race due to increased risk of glucose-6-phosphate dehydrogenase (G-6-PD) deficiency [163]; and darker skin due to melanin reducing visible skin yellowing [164]. Technology assisting these subgroup risk assessments cannot be built using currently existing data and would have to grapple with complex questions including how to code mixed-race or intersex neonates.…”

Section: Current Guidelines Including From the American Academy Of Pediatrics And International Lactationmentioning

confidence: 99%

Breastfeeding Insufficiencies: Common and Preventable Harm to Neonates

Wilde¹

2021

Cureus

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Insufficient milk intake in breastfed neonates is common, frequently missed, and causes preventable hospitalizations for jaundice/hyperbilirubinemia, hypernatremia/dehydration, and hypoglycemia - accounting for most U.S. neonatal readmissions. These and other consequences of neonatal starvation and deprivation may substantially contribute to fully preventable morbidity and mortality in previously healthy neonates worldwide. Previous advanced civilizations recognized this problem of breastfeeding insufficiencies and had an infrastructure to solve it: Wetnursing, shared nursing, and prelacteal feeding traditions used to be well-organized and widespread. Modern societies accidentally destroyed that infrastructure. Then, modern reformers missing a few generations of direct knowledge transmission about safe breastfeeding invented a new, historically anomalous conception of breastfeeding defined in terms of exclusivity. As that new intervention has become increasingly widespread, so too have researchers widely reported associated possible harms of the longer neonatal starvation/deprivation and later infant under-nutrition periods that it creates when breastfeeding is insufficient. Early insufficient nutrition/hydration has possible long-term effects including neurodevelopmental consequences such as attention deficit hyperactivity disorder, autism, cerebral palsy, cognitive and developmental delay, epilepsy, hearing impairment, kernicterus, language disorder, mood disorders, lower IQ, and specific learning disorder. Current early infant feeding guidelines conflict with the available evidence. Recent reform efforts have tended to focus on using more technology and measurement to harm fewer neonates instead of proposing the indicated paradigm shift in early infant feeding to prevent more harm. The scientific evidence is already sufficient to mandate application of the precautionary principle to feed neonates early, adequate, and often milk before mothers’ milk comes in and whenever signs of hunger persist, mitigating possible risks including death or disability. In most contexts, the formula is the best supplementary milk for infants at risk from breastfeeding insufficiencies. National-level reviews of scientific evidence, health policy, and research methods and ethics are needed to initiate the early infant feeding paradigm shift that the data already support. Policy experiments and related legislative initiatives might also contribute to the shift, as insurers might decline or be required by law to decline reimbursing hospitals for costs of this type of preventable hospitalization, which otherwise generates profit.

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“…As highlighted by Christopher Golden, MD, a better management strategy is necessary for the African American neonate. 52 Based on the biologic and nonbiologic contributors to kernicterus risk in African American individuals, potential interventions to mitigate this risk are reviewed. Focus is given to enhancing parentalhealthliteracyonneonataljaundiceandcareseekingwhilestrengthening newborn care clinicians' knowledge of the hazardous hyperbilirubinemia risk in black neonates and countering the inaccurate perceptions that allow this disparity to exist.…”

Section: Mitigating Kernicterus Risk In Black Neonatesmentioning

confidence: 99%

“…While these measures have reduced the incidence of severe, extreme, and hazardous hyperbilirubinemia in some health care systems, the kernicterus health disparity experienced by black infants makes it clear we need to rethink and reframe risk reduction strategies for this vulnerable population. As highlighted by Christopher Golden, MD, a better management strategy is necessary for the African American neonate . Based on the biologic and nonbiologic contributors to kernicterus risk in African American individuals, potential interventions to mitigate this risk are reviewed.…”

Section: Mitigating Kernicterus Risk In Black Neonatesmentioning

confidence: 99%