Tudehope D, Bayley G, Munro D, Townsend S
Department of Neonatology, Mater Misericordiae Public Hospital, South Brisbane, Queensland, Australia.
J Paediatr Child Health. 1991 Aug;27(4):240-4. doi: 10.1111/j.1440-1754.1991.tb00400.x.
This study establishes the association between early onset severe hyperbilirubinaemia (serum bilirubin (SBR) level greater than or equal to 272 mumol/L) with no assigned cause and breast feeding. The rates of breast feeding at hospital discharge increased from 46.4 to 75.4% in non-insured (public) women and 58.6 to 89.2% in insured (private) women between 1975 and 1987, and were accompanied by an increase in severe hyperbilirubinaemia from 1.6 to 3.1% in public and 0.9 to 3.6% in private babies. The case control study involved 125 term breast feeding infants born between 1 July 1985 and 1 July 1986 with severe hyperbilirubinaemia (SBR level 272 mumol/L) with no assigned cause who were compared with 125 matched controls who had peak SBR levels less than or equal to 272 mumol/L. Severe hyperbilirubinaemia was associated with primiparous and non-Caucasian mothers, non-smoking and oxytocin usage. Univariate analysis of feeding practice variables revealed that less frequent breast feeds, greater weight loss and less frequent stools over the first 3 days related to severe hyperbilirubinaemia (P less than 0.05). Multivariate analysis of the eight significant univariate factors revealed that maternal non-smoking, less frequent breast feeding, less frequent stooling and excessive infant weight loss were the best predictors of severe hyperbilirubinaemia. With the wide promotion of breast feeding, the contribution of individual feeding practices to severe hyperbilirubinaemia demands ongoing analysis and review.
本研究确定了无明确病因的早发性重度高胆红素血症（血清胆红素（SBR）水平大于或等于272μmol/L）与母乳喂养之间的关联。1975年至1987年间，非参保（公立）女性出院时的母乳喂养率从46.4%升至75.4%，参保（私立）女性则从58.6%升至89.2%，与此同时，公立婴儿的重度高胆红素血症发生率从1.6%升至3.1%，私立婴儿从0.9%升至3.6%。病例对照研究纳入了125名足月母乳喂养婴儿，这些婴儿于1985年7月1日至1986年7月1日出生，患有无明确病因的重度高胆红素血症（SBR水平为272μmol/L），并与125名匹配的对照进行比较，这些对照的SBR峰值水平小于或等于272μmol/L。重度高胆红素血症与初产妇、非白种人母亲、不吸烟以及使用催产素有关。对喂养方式变量的单因素分析显示，出生后头3天母乳喂养次数较少、体重下降较多以及排便次数较少与重度高胆红素血症相关（P<0.05）。对八个显著单因素的多因素分析显示，母亲不吸烟、母乳喂养次数较少、排便次数较少以及婴儿体重过度下降是重度高胆红素血症的最佳预测因素。随着母乳喂养的广泛推广，个体喂养方式对重度高胆红素血症的影响需要持续分析和审查。
