Jaundice, Terminating Breast-Feeding, and the Vulnerable Child

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Abstract
Jaundice is the most commonly treated condition of otherwise well newborns. Although recommended treatments are thought to be safe and effective, the impact of jaundice and therapy on maternal attitudes and behavior is unknown. It was hypothesized that, in contrast to comparison mothers, mothers of jaundiced infants would be more likely to stop breast-feeding in the first month of life, have more separation difficulties with their infant, and be greater users of health care. Both groups of mothers were surveyed in the hospital and 1 month after discharge. Mothers were eligible if their infants were born at Yale-New Haven Hospital after February 1987 and were in the regular nursery. Jaundiced infants had a total serum biirubin concentration ≥205 mmol/L (12 mg/dL); control infants were not jaundiced. Of those who agreed to participate, 84% (85/101) of mothers of jaundiced infants and 80% (124/155) of control mothers completed the 1-month questionnaire. There were no substantial differences between the control and jaundiced groups, respectively, with regard to maternal age (29.1 years vs 29 years) education (66% vs 60% some college), or race (86% vs 82% white). Breast-feeding was more common in the jaundiced group (61% vs 79%, P < 05). By 1 month, more mothers of jaundiced infants had completely stopped breast-feeding (19% vs 42%,P < .01). They were more likely to have never left the baby with anyone else (including the father) or left the baby at most one time for less than 1 hour (15% vs 31%, P < .05). Although they reported a similar number of infant health problems in the first month of life (35% vs 27%, control vs jaundiced group), mothers of jaundiced infants were more likely to take the baby for more than two well-child checkups (6% vs 17%, P < .05), more than one sick visit (9% vs 19%, P = .05), and any emergency room visit (2% vs 11%, P < .05) (not including visits for bilirubin measurements). These results suggest that jaundice and current therapies for it may increase the risk for premature termination of breast-feeding and for development of the vulnerable child syndrome.