Search

Objectives. Neonatal jaundice is a greater problem for infants fed breast milk, compared with formula. This study tested the hypotheses that feeding breastfed newborns [beta]-glucuronidase inhibitors during the first week after birth would increase fecal bilirnbin excretion and would reduce jaundice without affecting breastfeeding deleteriously. Methods. Sixty-four breastfed newborns were randomized to 4 groups, ie, control or receiving 6 doses per day (5 mL per dose) of L-aspartic acid, enzymatically hydrolyzed casein (EHC), or whey/casein (W/C) for the first week. L-Aspartic acid and EHC inhibit [beta]-glucuronidase. Transcutaneous bilirubin levels (primary outcome) were measured daily (Jaundice Meter [Minolta]Air Shields, Hatboro, PA] and Bilicheck [Respironics, Pittsburgh, PA]). All stools were collected, and fecal bile pigments, including bilirubin diglucuronide, bilirubin monoglucuronides, and bilirubin, were analyzed with high-performance liquid chromatography. Follow-up assessments included day 7 body weight, day 6/7 prebreastfeeding/postbreastfeeding weights, maternal ratings, and ages at formula introduction and breastfeeding cessation. Results. The groups were comparable at entry. Overall, the L-aspartic acid, EHC, and W/C groups had significantly lower transcutaneous bilirubin levels than did the control group (75.8%, 69.6%, and 69.2%, respectively, of the control mean, 8.53 mg/dL, at the bilirubin peak on day 4). The L-aspartic acid, EHC, and W/C groups had significantly lower transcutaneous bilirubin levels on days 3 to 7. Fecal bile pigment excretion was greatest in the L-aspartic acid group, significantly greater than control values. There were no significant differences in dosages, follow-up measurements, and maternal ratings. Conclusions. Use of minimal aliquots of L-aspartic acid and EHC for [beta]-glucuronidase inhibition results in increased fecal bilirubin excretion and less jaundice, without disruption of the breastfeeding experience. Decreased jaundice in the W/C group, which lacked a [beta]-glucuronidase inhibitor, suggests a different mechanism. Pediatrics 2005;116:385-391; neonate, jaundice, hyperbilirubinemia, breastfeeding, [beta]-glucuronidase, bilirubin. ABBREVIATIONS. EHC, enzymatically hydrolyzed casein; W/C, whey/casein; HPLC, high-performance liquid chromatography; BMG, bilirubin monoglucuronide; BDG, bilirubin diglucuronide; BP, bile pigment; AAP, American Academy of Pediatrics., Most newborns experience benign hyperbilirubinemia. Severe elevation of serum bilirubin levels, however, can result in brain damage known as kernicterus. (1,2) Infants with hyperbilirubinemia may require bilirubin surveillance, feeding changes, [...]

To the Editor.-- Gourley et al (1) provided preliminary and provocative data to suggest that administration of a specific [beta]-glucuronidase inhibitor as a concurrent, small-aliquot supplement with breastfeeding would reduce [...]