Wilde Vera K
Medicine, Methods, Ethics, and Technology, Independent Researcher, Berlin, DEU.
Cureus. 2022 Feb 23;14(2):e22512. doi: 10.7759/cureus.22512. eCollection 2022 Feb.
Meta-analyses consistently find a substantial possible association between neonatal jaundice (hyperbilirubinemia) and later autism risk. The obvious question this poses is "what is the source of this risk?" This review explores the complementary roles of jaundice severity and time, racial and geographic disparities, and early infant feeding regime change, and discusses potential implications of these findings. A range of factors appears to increase the risk of autism development following neonatal jaundice, all of which are associated with the "exclusive breastfeeding" paradigm. Severity presents an intuitive risk factor in the context of bilirubin neurotoxicity; jaundice from the modal root cause of insufficient milk intake progresses as that condition persists. Racial and geographic disparities present another intuitive set of risk factors, including a heightened risk of missed diagnosis for darker-skinned neonates and delayed care access in poorer settings. In addition to these intuitive factors, near- or full-term as opposed to preterm status and phototherapy treatment may also heighten risk. These counter-intuitive findings provide additional support for deprivation/starvation as a crucial antecedent or independent variable, and time as a mediator to progression in and subsequent risk from jaundice; heightened medical monitoring and supplementation seem to protect preterms, and phototherapy risks iatrogenesis, having replaced without sufficient safety evidence the prior standard treatment of switching jaundiced, breastfed babies to formula. Critically, jaundice associated with insufficient milk intake due to breastfeeding insufficiencies is fully preventable and trivially treatable with appropriate supplemental milk. Feeding neonates adequately may play an important role in preventing autism and other neurodevelopmental disorders including attention deficit hyperactivity disorder, cerebral palsy, epilepsy, hearing impairment, learning disorders, and mood disorders. Precautionary principle invocation is overdue.
荟萃分析一致发现新生儿黄疸（高胆红素血症）与日后患自闭症风险之间存在显著的潜在关联。由此引发的一个明显问题是“这种风险的来源是什么？” 本综述探讨了黄疸严重程度和时间、种族和地理差异以及早期婴儿喂养方式改变所起的互补作用，并讨论了这些发现的潜在影响。一系列因素似乎会增加新生儿黄疸后患自闭症的风险，所有这些因素都与 “纯母乳喂养” 模式相关。在胆红素神经毒性的背景下，严重程度是一个直观的风险因素；因母乳摄入不足这一常见根本原因导致的黄疸会随着这种情况的持续而加重。种族和地理差异是另一组直观的风险因素，包括皮肤较黑的新生儿漏诊风险增加以及在贫困地区获得护理的延迟。除了这些直观因素外，与早产状态相对的近足月或足月状态以及光疗治疗也可能增加风险。这些与直觉相悖的发现为剥夺 / 饥饿作为一个关键的先行因素或独立变量以及时间作为黄疸进展及后续风险的中介提供了额外支持；加强医疗监测和补充似乎能保护早产儿，而光疗存在医源性风险，在没有充分安全证据的情况下取代了之前将黄疸母乳喂养婴儿换成配方奶的标准治疗方法。至关重要的是，由于母乳喂养不足导致母乳摄入不足相关的黄疸是完全可以预防的，并且通过适当补充母乳很容易治疗。充分喂养新生儿可能在预防自闭症和其他神经发育障碍（包括注意力缺陷多动障碍、脑瘫、癫痫、听力障碍、学习障碍和情绪障碍）方面发挥重要作用。早就应该援引预防原则了。
