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The Role of Bilirubin Production in Breast-fed Infants with Elevated Serum Bilirubin Concentrations at 2 Weeks of Life

Department of Pediatrics, Stanford University School of Medicine, Stanford, CA 94305

Linda K. Kwong

Department of Pediatrics, Stanford University School of Medicine, Stanford, CA 94305

Hendrik J. Vreman

Department of Pediatrics, Stanford University School of Medicine, Stanford, CA 94305

David K. Stevenson

Department of Pediatrics, Stanford University School of Medicine, Stanford, CA 94305

The carboxyhemoglobin level (COHb), an accepted qualitative index of bilirubin production, was measured in normal, full-term, breast-fed (n = 9) or formula-fed (n = 11) infants at 2 days and 2 weeks of life. The mean COHb did not differ significantly at 2 days and 2 weeks in either of the groups, nor did the mean COHb differ between the groups at 2 weeks. The mean serum bilirubin concentration was lower in the formula-fed infants compared to the breast-fed infants at 2 weeks (p < 0.05). The mean serum bilirubin concentration decreased by only 14 percent among the breast-fed infants, and actually increased in three infants by 2 weeks. In comparison, the mean serum bilirubin concentration of the formula-fed infants decreased by 61 percent (p < 0.05), with the serum bilirubin concentration decreasing in each infant by 2 weeks. These findings are consistent with the generally held belief that bilirubin production is not the primary etiology of elevated serum bilirubin concentrations associated with breast-feeding in the second week of life. However, continued high bilirubin production at 2 weeks may contribute to the potential for significant jaundice in some infants with impaired hepatic function or increased enterohepatic circulation of bilirubin.

Clinical Pediatrics, Vol. 23, No. 9, 480-482 (1984)
DOI: 10.1177/000992288402300904


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