The role of bilirubin production in breast-fed infants with elevated serum bilirubin concentrations at 2 weeks of life.

The carboxyhemoglobin level (COHb), an accepted qualitative index of bilirubin production, was measured in normal, full-term, breast-fed (n = 9) or formula-fed (n = 11) infants at 2 days and 2 weeks of life. The mean COHb did not differ significantly at 2 days and 2 weeks in either of the groups, nor did the mean COHb differ between the groups at 2 weeks. The mean serum bilirubin concentration was lower in the formula-fed infants compared to the breast-fed infants at 2 weeks (p less than 0.05). The mean serum bilirubin concentration decreased by only 14 percent among the breast-fed infants, and actually increased in three infants by 2 weeks. In comparison, the mean serum bilirubin concentration of the formula-fed infants decreased by 61 percent (p less than 0.05), with the serum bilirubin concentration decreasing in each infant by 2 weeks. These findings are consistent with the generally held belief that bilirubin production is not the primary etiology of elevated serum bilirubin concentrations associated with breast-feeding in the second week of life. However, continued high bilirubin production at 2 weeks may contribute to the potential for significant jaundice in some infants with impaired hepatic function or increased enterohepatic circulation of bilirubin.