The impact of jaundice in newborn infants on the length of

breastfeeding

Adalat Khan

Reg# 2014-HIMP-1013

Research Duration

6th Months

Supervised By

Mazhar Islam

Hafeez Institute of Medical Sciences

Bacha Khan University Charsada

Contents
Introduction ....................................................................................................................... 3

Objectives of The Study.................................................................................................... 3

METHODS ........................................................................................................................ 4

Study design ................................................................................................................... 4

Patient selection ............................................................................................................. 4

Data collection ............................................................................................................... 4

Analysis .......................................................................................................................... 5

References .......................................................................................................................... 5
Introduction
Breastfeeding confers many advantages to infants, mothers, families and society in
general. There is strong evidence that human milk feeding decreases the incidence of
many infectious diseases and enhances the immunological status of the newborn. It has
been associated with enhanced performance on neurocognitive development tests and
provides important health benefits to the mother, including a decreased risk for breast and
ovarian cancers. Given the clear advantages that breast-feeding confers to young babies,
it should be strongly encouraged for at least the first six months of life, as recommended
in the World Health Organizations Innocenti Declaration.

Neonatal jaundice is one of the most common medical problems in healthy full-term
infants during the immediate postnatal period. There is controversy as to whether
breastfeeding increases the incidence of jaundice in the first few days of life. Many
studies have reported an association between breastfeeding and significant
hyperbilirubinemia, but others have not been able to substantiate this observation. In a
study conducted in Italy, neonatal jaundice was not associated with breastfeeding per se,
but rather with increased weight loss after birth subsequent to fasting, which can be seen
with inadequate lactation.

When an infant is hospitalized, previously established patterns of breastfeeding are

difficult to maintain. There is evidence to suggest that mothers of young infants admitted
to hospital with hyperbilirubinemia commonly experience guilt because they believe that
breastfeeding was the cause of the jaundice. The incidence of breastfeeding
discontinuation is believed to be higher among infants admitted to the hospital with
hyperbilirubinemia than among the general population, although this has never been well
documented.

Objectives of The Study

The objectives of the present study is to determine the prevalence of breastfeeding at
three and six months of age among mothers of infants previously admitted to the hospital
with hyperbilirubinemia, and to compare it with the prevalence of breastfeeding among
the general population in a Swat. Previously identified risk factors for early breastfeeding
discontinuation including young age, lower income, lower level of education and early
return to work, were also examined.

METHODS

Study design
The charts of all babies younger than one month of age admitted with a diagnosis of
hyperbilirubinemia to the Saidu Group of teaching Hospitals Saidu Sharif Swat will be
reviewed. Saidu Group of teaching Hospitals Saidu Sharif Swat is a tertiary care teaching
centre that provides paediatric care services to a population of 9.5 million people. Infants
admitted with jaundice present to the emergency department. They are either self-referred
or sent in by their health care provider. The charts will be retrieved from medical records.
A survey will be mailed to all eligible patients, accompanied by a letter signed by the
Chief of Paediatrics asking for consent to participate in the study. To maximize response,
a modified version of Dillmans total design method will be used. A maximum of three
questionnaires and two reminder postcards will be sent to every family, at regular two-
week intervals.

Patient selection
Patients will be eligible for the study based on the following criteria: any amount of
breastfeeding at the time of admission, younger than one month of age at the time of
admission, and Pushto speaking. Patients will be excluded if they were exclusively
formula-fed, had hyperbilirubinemia of the predominantly conjugated type, had
anatomical abnormalities (such as cleft lip or palate) potentially interfering with
breastfeeding, will be neurologically impaired, or are fed via nasogastric, nasojejunal or
gastric tube.

Data collection
Data collected will include maternal age at delivery, level of education achieved, total
household income, marital status, age of the baby when admitted to hospital, whether the
mother is told that breastfeeding is related to the babys jaundice, the type of help
received in the hospital and outside the hospital with regard to breastfeeding, age of the
child at the time of breastfeeding cessation, age of the child at the time of formula
introduction, age of the baby. Breastfeeding at three and six months of age will be
recorded for each baby, as well as age at formula introduction, if any.

Analysis
Descriptive statistics (frequency [percentage] and medians [range]) will be used to
summarize the survey respondents profile. The primary outcome for the present study
(ie, prevalence of breastfeeding at three and six months) will be calculated and CIs will
be obtained using the Wilson score with continuity correction. The prevalence of breast-
feeding will be compared with the prevalence in the General population using a one-
sample Z test. Age at breastfeeding discontinuation and formula introduction will be
compared among four factors believed to influence these outcomes using a nonparametric
approach (Kruskal-Wallis and Mann-Whitney U tests). The association between early
breast-feeding discontinuation and various sociodemographic and physician-support
characteristics will be assessed with logistic regression models.

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