Study of Incidence of Breastfeeding Failure Jaundice in Cases of Neonatal Hyperbilirubinemia in a Suburban Hospital

Background: Neonatal jaundice is the most common cause of readmission after discharge from birth hospitalization. Breastfeeding failure jaundice (BFFJ) is an important subtype of pathological neonatal jaundice. It typically occurs with lactation failure during the first postnatal week that leads to insufficient intake, dehydration, weight loss and sometimes hypernatremia. Incidence of breast-feeding failure is expected to rise as the exclusive breast-feeding rates are rising. This problem is not well studied especially in Indian setting hence study was conducted.Methods: This was retrospective observational study done in Department of Pediatrics from the April 1, 2016 to March 31, 2018. 179 neonates, who presented with jaundice as main complaint with total bilirubin value above the age & risk factor matched cut off, were sampled and their clinical data was analyzed.Results: Breast feeding failure jaundice contributed 31.8% (N = 57) cases, second to the exaggerated physiological hyperbilirubinemia (48% N = 86), followed by hemolytic (13.8%, N = 25). BFFJ presented at median age of 6.8 days and had mean duration of hospital stay of 3 days. Incidences of exaggerated physiological jaundice and BFFJ were found to be higher in winter months i.e. 6.7% (N = 48/716) compared to summer months i.e. 4.1% (N = 28/679) significantly (p value = 0.045).Conclusions: Breast feeding failure jaundice (BFFJ) contributed to one third of cases of neonatal pathological jaundice requiring re-admission and is the second most common cause after exaggerated physiological jaundice. The high incidence of BFFJ in the study warrants focused efforts for a structured program of breast-feeding education, training and surveillance.