Evaluation of Bilirubin Level in Exclusively Breastfed Versus Formula-Fed Infants: A Retrospective Comparative Study

Abstract

Background: Neonatal jaundice is one of the most common clinical conditions encountered during the neonatal period, affecting approximately 60% of term and 80% of preterm newborns. Feeding practices play a significant role in bilirubin metabolism and may influence the incidence and severity of neonatal hyperbilirubinemia. Exclusive breastfeeding has been associated with a higher frequency of physiological jaundice compared to formula feeding.
Aim: To compare serum bilirubin levels among exclusively breastfed and formula-fed infants and evaluate the association between feeding pattern and neonatal hyperbilirubinemia.
Materials and Methods; A retrospective comparative study was conducted at the Department of Pediatrics, DRIEMS Medical College and Hospital, Tangi, Cuttack, Odisha, over a one-year period. Medical records of 100 neonates were reviewed, including 50 exclusively breastfed infants and 50 formula-fed infants. Demographic characteristics, gestational age, birth weight, age at bilirubin estimation, total serum bilirubin (TSB) levels, and requirement for phototherapy were analyzed. Statistical analysis was performed using SPSS version 26. Independent t-test, Chi-square test, and logistic regression analysis were used. A p-value <0.05 was considered statistically significant.
Results: The mean total serum bilirubin level was significantly higher among exclusively breastfed infants (13.28 ± 3.14 mg/dL) compared to formula-fed infants (9.86 ± 2.71 mg/dL) (p<0.001). Hyperbilirubinemia requiring phototherapy occurred in 18 (36.0%) breastfed infants and 7 (14.0%) formula-fed infants (p=0.011). Exclusive breastfeeding was independently associated with elevated bilirubin levels (OR=3.46, 95% CI:1.34–8.92, p=0.010).
Conclusion: Exclusively breastfed infants demonstrated significantly higher bilirubin levels and a greater requirement for phototherapy compared to formula-fed infants. Careful monitoring of bilirubin levels among breastfed neonates may facilitate early identification and management of neonatal jaundice.