A controlled, randomized, double-blind trial of prophylaxis against jaundice among breastfed newborns.

Abstract

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 bilirubin 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.

• Authors: Glenn R Gourley, Zhanhai Li, Bill L Kreamer, Michael R Kosorok
• Journal: Pediatrics (Pediatrics) Vol. 116 Issue 2 Pg. 385-91 (Aug 2005) ISSN: 1098-4275 [Electronic] United States
• PMID: 16061593 (Publication Type: Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)

Chemical References

• Bile Pigments
• Caseins
• Milk Proteins
• Whey Proteins
• Aspartic Acid
• casein hydrolysate
• Glucuronidase
• Bilirubin

Topics

• Aspartic Acid (administration & dosage)
• Bile Pigments (analysis)
• Bilirubin (analysis, blood)
• Breast Feeding
• Caseins (administration & dosage)
• Double-Blind Method
• Feces (chemistry)
• Glucuronidase (antagonists & inhibitors)
• Humans
• Infant, Newborn
• Jaundice, Neonatal (metabolism, prevention & control)
• Milk Proteins (administration & dosage)
• Whey Proteins