Treatment for Phototherapy

1. Phototherapy for the Treatment of
Neonatal Jaundice and Breastfeeding
Duration and Exclusivity
Ajeng Agustin Primastiwi

2. Introduction
 neonatal jaundice remains one of the most commonly treated conditions of the
newborn infant
 one study finding that 7.6% of all infants receive phototherapy in the first few days
of life
 it is unclear whether or not the increased screening and treatment of jaundice has
led to fewer cases of kernicterus
 it may be important to reassess current recommendations
 The purpose of this study is to determine if the association between treatment of
jaundice with phototherapy and a shorter duration of breastfeeding continues to
exist in a more recent cohort of infants

3. Materials and Methods
 a cohort study analyzing data collected for the Infant Feeding Practices Study II
(IFPS II)
 4,000 pregnant women were enrolled between May and December 2005
 participants must have given birth to a healthy, singleton infant of greater than 35
weeks gestation weighing at least 2.2 kg
 questionnaires were mailed to participants prenatally, Questions were asked about
breastfeeding intentions and practices, as well as infant formula use.

4. Inclusion and exclusion criteria and Data
collection
 Infants were included if their mothers ever initiated breastfeeding
 A small group of infants were excluded who indicated ‘‘other’’ treatment for
jaundice, which included switching completely to infant formula.
 For the study, we abstracted information on maternal age, race and ethnicity,
education level, marital status, and household income from the IFPS II.
 Maternal intention to exclusively breastfeed was determined by a question on the
prenatal survey that asked, ‘‘What method do you plan to use to feed the baby in
the first few weeks
 We also included data to determine use of supplemental infant formula on the first
day of life and any breastfeeding problems the mother had during the first 2 weeks

5. Outcomes and Exposure
 The primary outcomes of our study were any breastfeeding at 1, 2, 4, 6, 9, and 12
months of age
 The secondary outcomes included exclusive breastfeeding at 1, 2, and 4 months of
age
 The main exposure of interest for our study was whether the infant received
phototherapy for the treatment of jaundice in the newborn period
 Exposure to phototherapy was determined by parental report on the IFPS II survey
when a study infant was *3 weeks old
 Data on the presence of jaundice were missing for 42.2% of newborns who were
included in the analyses
 reanalyzed our study data after excluding newborns with missing information on
the presence of jaundice.

6. Analysis
 Logistic regression models were developed to evaluate the association between the
dichotomous outcomes for both any breastfeeding and exclusive breastfeeding
and exposure to phototherapy at each time point
 All models were adjusted for the potential confounders of maternal age, race,
maternal education, household income, and gestational age at birth

7. Results
 The IFPS II had an overall sample size of 4,902 infants
 We excluded 461 infants because they were never breastfed, This yielded a study sample size of 4,441
infants
 1,098 (25%) were reported to have some degree of jaundice by their caregiver. A total of 220 (5%)
study infants required phototherapy
 A further 205 infants were excluded from analysis because they indicated ‘‘other’’ treatment for
jaundice
 30% of women were still breastfeeding at 12 months of age and 27% were exclusively breastfeeding at
4 months
 Infants in the phototherapy exposed group were also significantly more likely to receive formula
supplementation on day of life 1 than those in the phototherapy unexposed group, 25.5% compared
with 15.4%
 At month 12, infants who were exposed to phototherapy were less likely to still be breastfed than
infants who were not exposed to phototherapy (OR 0.58, 95% CI 0.38–0.87)

8. Result

9. Result

10. Result

11. Discussion
 infants received phototherapy were as likely to be receiving any breast milk
through 9 months of age as those whose infants did not receive phototherapy
 Only by 12 months of age were they less likely to be receiving any breast milk than
their nonphototherapy exposed counterparts
 Phototherapy treatment was associated with decreased rates of exclusive
breastfeeding throughout the first 4 months of life
 the decreased breastfeeding observed at 12 months of age and this finding may be
a statistical fluke

12. Several possible explanations for why we did not
observe the early abandonment of breastfeeding that
Kemper et al. found
 First, infants for the study by Kemper et al. were recruited from a single hospital
compared to the national sample that we evaluated
 breastfeeding counseling practices and even maternal motivation to continue
breastfeeding could have been different among this population than the more
nationally representative population in our study
 In the study by Kemper et al., all phototherapy was done in an in-patient setting, .
In our study, it was not possible to know if an infant was treated with hospital-
based or home-based phototherapy
 , the Kemper et al. study was done nearly 30 years ago, It is likely that much of the
observed difference in study findings is due to greater breastfeeding support and
encouragement in our newborn nurseries

13.  a significant decrease in rates of exclusive breastfeeding among phototherapy
exposed infants during the first 4 months of life
 This may be due to breastfeeding-related messaging parents receive from
healthcare professionals while their infants undergo treatment for jaundice
 mothers of jaundiced infants may internalize the message from providers (either
spoken or unspoken) that their breast milk is not enough for the baby and either
begin or continue to supplement their infant with formula

14. Limitation
 There are several limitations to this study. First, the data are now several years old
and were not collected for the purpose of answering this question
 all data obtained rely on parental report. Although it is likely that parents would
remember whether or not their newborn required phototherapy and how the infant
was fed over the previous 1– 2 months, undoubtedly this recall is not perfect

15. Conclusion
 It is encouraging that increased vigilance about neonatal jaundice, with the
concomitant increase in phototherapy use, does not seem to be leading to a
significant decrease in the duration of any breastfeeding.
 Communication related to exclusive breastfeeding in a child receiving
phototherapy may need to be evaluated to ensure that, as much as possible,
 exclusive breastfeeding is supported in newborns receiving phototherapy who are
not in need of extra fluid for hydration, thereby preserving a mother’s confidence
in her ability to exclusively breastfeed after treatment is completed.

16. Thank you