Breastfeeding jaundice: how big is the problem?

Background: Breastfeeding jaundice is jaundice requiring phototherapy where dehydration (weight loss more than 10% of the birth weight) was the only cause. Weight loss more than 10% is seen in 7% of term neonates. Objective of the study is to determine the prevalence and impact of inadequate breastfeeding on jaundice among neonates (>35 weeks) requiring phototherapy. Methods: The data for this study was taken from an observational study carried out in the neonatal unit of a tertiary care hospital for determining the incidence of jaundice without a known etiology. 200 eligible neonates were analyzed along the lines of peak bilirubin, onset of clinically significant jaundice and duration of phototherapy. Data was analyzed for the prevalence and impact of inadequate breastfeeding (leading to >10% weight loss) on jaundice. Results: Eighty seven (43.5%) subjects had no cause for jaundice and were classified as “physiological jaundice”. The remaining 113 babies were classified as “non-physiological jaundice”. 39 (19.5%) of the 113 babies had only dehydration as the cause and was called breastfeeding jaundice. 21 (10.5%) of the remaining 74 babies had dehydration contributing to the cause of non-physiological jaundice. Thus 50% of babies with non-physiological jaundice had dehydration contributing to the jaundice. The “breastfeeding jaundice” group had a lower peak bilirubin (p=0.02) and a later onset of jaundice requiring phototherapy (p=0.04) as compared to the rest of the pathological group. Conclusions: Inadequate breast feeding contributes to 50% of non-physiological jaundice. Aggressive lactation support, with daily weight monitoring can reduce the requirement of phototherapy by 30%.