Masayoshi Zaitsu1,2, Tatsuya Yoshihara3,4, Hiromitsu Nakai5, Shiro Kubota6,7. 1. Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA. 2. Department of Public Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan. 3. Kubota Maternity Clinic, Fukuoka, Japantatsuya@clipharm.med.kyushu-u.ac.jp. 4. Clinical Research Center, Fukuoka Mirai Hospital, Fukuoka, Japantatsuya@clipharm.med.kyushu-u.ac.jp. 5. YOU-YOU General Infirmary, Karatsu/Saga, Japan. 6. Kubota Maternity Clinic, Fukuoka, Japan. 7. Kubota Life Science Laboratory Co., Ltd., Saga, Japan.
Abstract
BACKGROUND: Neonatal jaundice is strongly attributable to excess body-weight loss as a result of insufficient calorific intake. OBJECTIVES: To examine the incidence of neonatal jaundice (defined by use of phototherapy) and body-weight loss, as well as their association, among neonates under optimal thermal control with sufficient nutrition, a local protocol for temperature and nutritional regulation. METHODS: We retrospectively identified a cohort of 10,544 neonates (birth weight ≥2,500 g) placed in thermo-controlled incubators for 2 h immediately after birth. Neonates were fed with 5% glucose solution 1 h after birth and breastfed every 3 h (with supplementary formula milk if applicable) according to basal maintenance expenditure. Total serum bilirubin levels at day 4 (peak level) were assessed. Phototherapy was performed on the basis of total serum bilirubin level ≥18 mg/dL. Risk ratio (RR) and 95% CI for the use of phototherapy against maximum body-weight loss were estimated using Poisson regression with robust variance. RESULTS: Incidence of phototherapy use was low (0.3%) and the mean total serum bilirubin level was 8.5 mg/dL (SD 2.7 mg/dL), with a low mean maximum body-weight loss (1.9%) and low incidence of excess body-weight loss ≥7% (0.4%). Maximum body-weight loss was associated with risk of neonatal jaundice (RR 1.27; 95% CI 1.04-1.54), and became significant at approximately 4% of maximum body-weight loss. CONCLUSION: Optimal thermal control and sufficient nutrition may greatly reduce the incidence of neonatal jaundice by preventing neonatal body-weight loss.
BACKGROUND:Neonatal jaundice is strongly attributable to excess body-weight loss as a result of insufficient calorific intake. OBJECTIVES: To examine the incidence of neonatal jaundice (defined by use of phototherapy) and body-weight loss, as well as their association, among neonates under optimal thermal control with sufficient nutrition, a local protocol for temperature and nutritional regulation. METHODS: We retrospectively identified a cohort of 10,544 neonates (birth weight ≥2,500 g) placed in thermo-controlled incubators for 2 h immediately after birth. Neonates were fed with 5% glucose solution 1 h after birth and breastfed every 3 h (with supplementary formula milk if applicable) according to basal maintenance expenditure. Total serum bilirubin levels at day 4 (peak level) were assessed. Phototherapy was performed on the basis of total serum bilirubin level ≥18 mg/dL. Risk ratio (RR) and 95% CI for the use of phototherapy against maximum body-weight loss were estimated using Poisson regression with robust variance. RESULTS: Incidence of phototherapy use was low (0.3%) and the mean total serum bilirubin level was 8.5 mg/dL (SD 2.7 mg/dL), with a low mean maximum body-weight loss (1.9%) and low incidence of excess body-weight loss ≥7% (0.4%). Maximum body-weight loss was associated with risk of neonatal jaundice (RR 1.27; 95% CI 1.04-1.54), and became significant at approximately 4% of maximum body-weight loss. CONCLUSION: Optimal thermal control and sufficient nutrition may greatly reduce the incidence of neonatal jaundice by preventing neonatal body-weight loss.