• Vol. 38 No. 3, 217–224
  • 15 March 2009

Differential Risk for Early Breastfeeding Jaundice in a Multi-ethnic Asian Cohort



Introduction: To explore the relationship between ethnic origin and mode of feeding with early neonatal jaundice, we examined maternal and neonatal risk factors for hyperbilirubinaemia in a multi-ethnic Asian cohort of healthy term newborns. Materials and Methods: This is an observational cohort study in a maternity ward serving a multi-ethnic cosmopolitan community. The relationship between hyperbilirubinaemia (bilirubin ≥150 mmol/L before 48 hours to 72 hours after birth), ethnic origin, weight loss after birth, need for phototherapy, and other factors were examined. Bivariate comparisons and binary logistic regression were used to investigate the relationship between hyperbilirubinaemia/phototherapy with maternal and neonatal risk factors. Results: A consecutive group of 1034 neonates (56% Chinese, 24% Indian subcontinent, 9% Malay) with birth weights ≥2500 g was investigated. Overall factors that contributed significantly to hyperbilirubinaemia/phototherapy were gestational age, Chinese ethnic origin, weight loss of ≥7%, vaginal delivery, glucose-6-phosphate-dehydrogenase (G6PD) deficiency, breastfeeding and ABO incompatibility. Chinese neonates who were totally breastfed had a higher risk for jaundice [adjusted odds ratio (OR) = 1.64; 95% confidence intervals (CI), 1.11- 2.44; P <0.014], and phototherapy (adjusted OR = 2.75; 95% CI 1.77-4.27; P <0.001) compared to those supplemented with, or totally formula fed. In contrast, the risk of jaundice for non-Chinese infants did not differ according to the mode of feed. Although weight loss as a whole increased the risk for jaundice (adjusted OR = 1.43; 95%CI, 1.03-1.99; P = 0.031), jaundice in Chinese neonates was not due to ineffective breastfeeding because both Chinese and non-Chinese breastfed infants lost similar weights. Conclusions: Chinese ethnic origin was an independent risk factor for hyperbilirubinaemia and phototherapy. Breastfeeding was not a risk factor for hyperbilirubinaemia/phototherapy in non-Chinese Asian infants.

Early-onset hyperbilirubinaemia is a high-risk condition because it often presents with an acute and rapid rise in bilirubin values. Although the outcome for most is benign, infants with extremely high serum bilirubin can develop acute bilirubin encephalopathy in the absence of urgent intervention.1 Human milk is universally recognised as the optimal feed for all infants. However, reports from the 1960s indicate that breastfeeding is a risk factor for severe hyperbilirubinaemia.2-4 Kernicterus has re-emerged as a significant concern in the last 15 years5 and breastfeeding has been suggested as a contributing factor, since 98% of kernicteric infants were exclusively breastfed compared to the US national average of 68%.6

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