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K. L. Tan, FRCPE, FRACP, DCH

Arch Pediatr Adolesc Med. 1998;152:1187-1190.

Objective  To evaluate the efficacy of phototherapy for nonhemolytic hyperbilirubinemia in breast-fed and formula-fed infants and infants receiving formula and breast milk.

Design  Prospective study.

Setting  Nursery for healthy infants.

Method  Full-term healthy infants with nonhemolytic hyperbilirubinemia (bilirubin concentration, >255 µmol/L [14.9 mg/dL] or 222 µmol/L [13.0 mg/dL] at ages younger than 48 hours) were treated with conventional phototherapy by using daylight fluorescent lamps. Three groups of infants were studied: group 1, formula-fed infants; group 2, breast-fed infants; and group 3, infants receiving formula and breast milk. All patterns of feeding started at birth. Phototherapy was terminated only when bilirubin concentrations had decreased to less than 185 µmol/L (10.8 mg/dL); the minimum exposure period was 24 hours.

Results  A total of 163 infants were studied: group 1, 79; group 2, 34; and group 3, 50. The age at the start of exposure was comparable in all groups. The mean±SD weight loss as a percentage of birth weight was as follows: group 1, 2.8%±5.0%; group 2, 6.1%±3.4%; and group 3, 3.2%±2.6%. The duration of exposure to phototherapy was as follows: group 1, 54.1±20.8 hours; group 2, 64.6±25.1 hours; and group 3, 54.9±21.5 hours; the 24-hour rate of decrease in the bilirubin concentration was as follows: group 1, 18.6%±11.7%; group 2, 17.1%±9.6%; and group 3, 22.9%±9.4%. The overall rate of decrease in the bilirubin concentration for the duration of exposure to phototherapy was as follows: group 1, 0.8%±0.3% per hour; group 2, 0.6%±0.3% per hour; and group 3, 0.8%±0.3% per hour. Weight loss at the start of phototherapy was significantly greater in group 2 compared with group 1 (P<.001) and group 3 (P<.001), although the hemoglobin and hematocrit values were comparable. The duration of exposure to phototherapy was not significantly different in the 3 groups (P=.06); however, the duration of exposure of group 2 infants was 10 hours more than that of the other 2 groups. The 24-hour rate of decrease in the bilirubin concentration in group 3 was significantly better than that of group 2 (P=.007) and group 3 (P=.02); the rates of decrease for groups 2 and 3 were similar (P=.52). The overall rate of decrease in the bilirubin concentration during the duration of exposure to phototherapy in group 2 was significantly less than that of group 1 (P=.002) and group 3 (P<.001); the rates for groups 1 and 3 were similar (P=.35). The postexposure rebound bilirubin concentrations were comparable in all groups during the first 2 days; however, the duration of moderate jaundice in group 2 was more prolonged.

Conclusions  The response to phototherapy of group 2 infants was significantly slower than that of group 3 and group 1 infants; this response was still of adequate efficacy. The addition of formula to the feedings for totally breast-fed infants, without suspension of breast-feeding, would enhance the efficacy of phototherapy and reduce exposure time.

From the Department of Neonatology, National University Hospital, Singapore, Republic of Singapore.

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