Neonatal jaundice and stool production in breast- or formula-fed term infants

Abstract

It has remained unclear whether the amount of fecal fat excreted in the stool and stool production influences the severity of neonatal jaundice. We determined the relationship between stool production, fecal fat excretion and jaundice in healthy breast-fed (BF) or formula-fed (FF) (near-)term neonates. From postnatal day 1-4, we quantitatively collected stools from 27 FF and 33 BF infants in daily fractions. Stool production and fecal fat contents were related to unconjugated bilirubin (UCB) levels, as determined by transcutaneous bilirubinometry (TcB). Bilirubin concentrations and stool production did not differ between FF and BF neonates during the study period. Neonatal bilirubin levels were not inversely correlated with stool production. FF and BF infants had similar fecal fat excretion rates. The stool production of FF infants was profoundly lower in the present study than in a 1985 study by De Carvalho et al. [J Pediatr (1985) 107:786-790]. We conclude that increased jaundice during the first postnatal days in healthy term neonates can no longer be attributed to breast-feeding and speculate that improved absorbability of formulas since 1985 has contributed to similar fat excretion and stool production in FF and BF neonates in 2007.

Fig. 1

Transcutaneous bilirubin levels measured in breast-fed (BF) and formula-fed (FF) infants during the first postnatal days. Bilirubin levels did not differ significantly between BF (n = 33) and FF (n = 27) in any of the first 4 days after birth. Values represent means ± standard error of the mean (SEM). No significant differences were found. Tc Transcutaneous. [17.1 μmol/l unconjugated bilirubin (UCB) equals 1 mg/dl UCB]

Fig. 2

Cumulative stool production in FF and BF infants during the first 4 postnatal days In the first 4 postnatal days the total amount of stool production did not significantly differ between BF (n = 27) and FF (n = 21) infants. Values represent means ± SEM. Differences between the two groups of infants were not statistically significant at any of the days studied

Fig. 3

Cumulative fecal fat excretion (in grams per day) in BF (n = 27) and FF infants (n = 21) Cumulative fecal fat excretion in FF infants was similar to that in BF infants during first 4 postnatal days. Values represent means ± SEM. No significant differences were found

Fig. 4

The relationship between transcutaneous (Tc) bilirubin levels and cumulative stool production in the first postnatal days of BF and FF term neonates. TcB levels in both BF and FF infants (n = 48) at postnatal day 3 are not correlated with cumulative stool production between post-partum day 0 and day 3 (R² = 0.0055 for BF, R² = 0.0004 for FF infants)

Fig. 5

The relationship between TcB levels and cumulative fecal fat excretion in the first postnatal days of BF and FF term neonates. TcB levels in both BF and FF infants (n = 48) at postnatal day 3 are not correlated with cumulative fecal fat excretion between day 0 and day 3(r² = 0.019 for BF, r² = 0.065 for FF infants)

Fig. 6

Cumulative weight of stools in the first postnatal days in BF and FF infants: a comparison of data from De Carvalho et al.’s 1985 study [7] and the present study. FF infants in the present study produced less stool than the FF infants in De Carvalho et al.’s study. In contrast, BF infants produced similar amounts of stool as those studied in 1985