Did exclusive breast-feeding and early discharge lead to excessive XXXX levels in newborns in Antigua and Barbuda?

@entity1 @entity295 @entity3082 @entity648 @entity34372
Hyperbilirubinaemia is a common neonatal problem worldwide and is the leading cause of admission to the Special Care Nursery in Antigua and Barbuda. In 1990, the Innocenti Declaration in support of breast-feeding led to the adoption of the Baby-Friendly Hospital Initiative in many countries of the Caribbean, including Antigua and Barbuda. Comparing 1989 to the years 1992 to 1994, the Special Care Nursery at Holberton Hospital experienced a 40% increase in newborns admitted with hyperbilirubinaemia (peak total @entity648 > 12 mg/dl or 205 mumol/l). A retrospective review of Special Care Nursery and Maternity Ward records was undertaken to determine the incidence and aetiology of hyperbilirubinaemia from 1992 to 1994. There were 3721 @entity1 born in Antigua and Barbuda in those years, 98% of Afro-Caribbean or mixed ancestry. The overall incidence of peak total @entity648 over 12 mg/dl (205 mumol/l) was 12.5% (466/3721), not inconsistent with the reported incidence of 8 to 20% in other countries. However, the incidence of higher levels of hyperbilirubinaemia in Antigua and Barbuda exceeded those reported for other countries. In Antigua and Barbuda, total @entity648 of 15 mg/dl (255 mumol/l) or higher was found in 263 of 3721 @entity1 (7.1%) compared to 5.9% in India and 2% of breast-fed @entity1 in the United States of America (USA). Total @entity648 of 20 mg/dl (340 mumol/l) or higher was seen in 91 of 3721 @entity1 (2.5%) exceeding reported prevalence in the USA for both African-American and Caucasian @entity1 (1%) and equal to the reported prevalence in Asian @entity1 (2%). The possible aetiologies of hyperbilirubinaemia in neonates with total @entity648 18 mg/dl (306 mumol/l) or higher in our @entity1 were investigated. Medical records of 134 of 156 (86%) @entity1 having this level of hyperbilirubinaemia were available for review. The possible reason for hyperbilirubinaemia was ABO incompatibility in 4/134 (3%), @entity34372 in 1/134 (1%), prematurity in 12/134 (9%) and @entity295 neonatorum in 21/134 (16%). The hyperbilirubinaemia was idiopathic in 96/134 (71%) @entity1 . Newborns in Antigua and Barbuda were discharged 3.7 days after their mothers' admission, with 50% discharged prior to 48 hours of age. Early discharge in developed countries has led to increased readmissions for hyperbilirubinaemia. Following the appointment of a dietitian to supervise breast-feeding, admissions for hyperbilirubinaemia fell by 50% by 1998. These data suggest that exclusive breast-feeding and early discharge led to an @entity3082 in Antigua and Barbuda.
