Optimal Thermal Control with Sufficient Nutrition May Reduce the Incidence of Neonatal Jaundice by Preventing Body-Weight Loss Among Non-Low Birth Weight Infants Not Admitted to Neonatal Intensive Care Unit

Abstract

Background: Neonatal jaundice is strongly attributable to excess body-weight loss as a result of insufficient calorific intake. Objectives: To examine the incidence of neonatal jaundice (defined by use of phototherapy) and body-weight loss, as well as their association, among neonates under optimal thermal control with sufficient nutrition, a local protocol for temperature and nutritional regulation. Methods: We retrospectively identified a cohort of 10,544 neonates (birth weight ≥2,500 g) placed in thermo-controlled incubators for 2 h immediately after birth. Neonates were fed with 5% glucose solution 1 h after birth and breastfed every 3 h (with supplementary formula milk if applicable) according to basal maintenance expenditure. Total serum bilirubin levels at day 4 (peak level) were assessed. Phototherapy was performed on the basis of total serum bilirubin level ≥18 mg/dL. Risk ratio (RR) and 95% CI for the use of phototherapy against maximum body-weight loss were estimated using Poisson regression with robust variance. Results: Incidence of phototherapy use was low (0.3%) and the mean total serum bilirubin level was 8.5 mg/dL (SD 2.7 mg/dL), with a low mean maximum body-weight loss (1.9%) and low incidence of excess body-weight loss ≥7% (0.4%). Maximum body-weight loss was associated with risk of neonatal jaundice (RR 1.27; 95% CI 1.04–1.54), and became significant at approximately 4% of maximum body-weight loss. Conclusion: Optimal thermal control and sufficient nutrition may greatly reduce the incidence of neonatal jaundice by preventing neonatal body-weight loss.