LLLI Center for Breastfeeding Information

Journal Abstract of the Month for September 2004

"Management of Hyperbilirubinemia in the Newborn Infant 35 or More Weeks of Gestation"

Author: AAP Subcommittee on Hyperbilirubinemia:

M. Jeffrey Maisels, MB, BCh
Richard D. Baltz, MD
Vinod K. Bhutani, MD
Thomas B. Newman, MD, MPH
Heather Palmer, MB, BCh
Warren Rosenfeld, MD
David K. Stevenson, MD
Howard B. Weinblatt, MD

Pediatrics 2004 July; 114(1):297-316

Jaundice occurs in most newborns and most is benign. The focus of this clinical practice guideline is to reduce the incidence of severe hyperbilirubinemia. In every infant it is recommended that clinicians promote and support successful breastfeeding. It is important to recognize that infants at less than 38 weeks’ gestation, particularly those who are breastfed, are at higher risk of developing hyperbilirubinemia and will require closer surveillance and monitoring. Clinicians should advise mothers to nurse their infants at least 8 to 12 times per day. Providing appropriate support and advice to breastfeeding mothers increases the likelihood that breastfeeding will be successful. The AAP recommends against supplementation of nondehydrated breastfed infants with water or dextrose water because the evidence shows that it harms not benefits. The adequacy of intake should be evaluated and the infant monitored if the weight loss is more than 10%. Evidence of adequate intake in breastfed infants also includes at least 4 wet diapers in 24 hours, and the passage of 3 to 4 stools per day, by the fourth day. By the third to fourth day most stools in adequately breastfed infants are changing from meconium to a mustard yellow stool. This assessment will help to identify the breastfed infants that are at risk of dehydration because of inadequate intake. Supplementation with expressed breast milk is appropriate if the infant’s intake seems inadequate. Kernicterus should be largely preventable if health care personnel follow the recommendations listed in this guideline.

This paper is being categorized with the following keyword:

Jaundice

To view this Clinical Practice Guideline on the Management of Hyperbilirubinemia go to this link on the American Academy of Pediatrics (AAP) Web site:

http://aappolicy.aappublications.org/cgi/content/full/pediatrics;114/1/297