IOSR Journal of Nursing and Health Science (IOSR-JNHS

e-ISSN: 2320–1959.p- ISSN: 2320–1940 Volume 6, Issue 1 Ver. VII (Jan. - Feb. 2017), PP 76-80
www.iosrjournals.org

The Differences in the Disappearance of Physiological Jaundice

in the Newborns on Exclusive Breast-Feeding and Those of Non-
Exclusive Breast-Feeding
Gumiarti*
*Health Politechnic of Malang, Republic of Indonesia

Abstract: Neonatal Jaundice is a clinical condition characterized by the yellow coloration of the skin and the
sclera as the result of the accumulation of uconjugated hyperbilirubin level in the newborns’ blood. Jaundice
clinically appears in the newborns when the level of bilirubin in the blood ranges from 5-7 mg/dl. Bilirubin in
neonate is two to three times higher than the normal adult, because the number of erythrocytes in neonate is
higher and the age is shorter. About 50% of full term and 75% of preterm newborns suffer from jaundice. The
purpose of this study was to determine differences in the disappearance of jaundice in neonates on exclusive
breast-feeding and non-exclusive breast-feeding. This study was observational, cross sectional design, while
the population was mothers of newborns with physiological jaundice as many as 60 people, 56 of whom were
chosen as the samples. Accidental sampling was applied and the measuring instruments used questionnaire
and observation sheet. The results showed that the first emergence of physiological jaundice to neonates on
exclusive breast-feeding was averagely 2.65 days and averagely 2.70 days to neonates on non-exclusive
breast-feeding. The disappearance of physiological jaundice to neonates on exclusive breast-feeding took
about 5.77 days and to neonates on non-exclusive breastfeeding took about 7.90 days. The result of the t-test
showed that the p value was 0.000 (ρ=0,000), meaning that the physiological jaundice to neonates on
exclusive breast-feeding disappeared faster than neonates on non-exclusive breast-feeding. Thus the mother
should be encouraged to breast-feed frequently. The newborns should be exclusively breast-fed with no top
feeds, water, or dextrose water, as the protein in breast-feeding can coat the intestinal mucosa, so the liver of
the baby will be mature enough to get rid of bilirubin in the bloodstream.
Keywords: Jaundice, Exclusive Breast-feeding, non-Exclusive Breast-feeding.

I. Introduction
The epidemiological data showed that over 50% of newborns suffering from jaundice could be
detected clinically in the first week of life. In most cases of neonatal jaundice, bilirubin levels were harmless
and did not require treatment, most of which did not have the basic causes or called physiological jaundice and
would disappear at the end of the first week of life in normal term infants. Other rarely causes reported were
hemolysis, septicemia, and metabolic disease (non-physiological jaundice). Neonatal jaundice is a clinical state
of the newborn marked with the yellowing of the skin and the sclera of the eye due to accumulation of
unconjugated hyperbilirubin. Jaundice clinically will appear in the newborn when the level of bilirubin in the
blood ranges 5-7 mg/dl (Hasan, 2005). Bilirubin in neonates is produced two to three times higher than in
normal adults, as the number of erythrocytes in neonates is higher and the age s shorter. Many newborns,
especially those weighing less than 2500 grams suffer jaundiced in the first week of life.
The number of jaundice case is about 50% in full term infants and 75% in preterm ones. These cases
vary from one place to another place influenced by the management of neonates that has a lot of progress lately
(Prawiroharjo, 2006). Breast-milk is an emulsion of fat in the solution of proteins, lactose and organic salts
secreted by breast (mammary) glands as the primary food for the baby. First milk or colostrums, containing
many immunoglobulin A(IgA), is substantially very important to protect the infants against disease. Exclusive
breast-feeding is an unequalled way of prividing ideal food for the healthy growth and developments of infants
especially until six months of age.According Hasvivin (2013) exclusively breast-fed babies were proned to
suffer jaundice by (2.7%), while non-exclusively breast-fed babies were a lot higher to suffer jaundice by
(32.4%). The number of jaundice in newborns with normal weight was by (5.4%) and in newborns with low
birth weight experienced by (29.7%). The impacts when a baby suffered from jaundice and did not receive
proper and fast treatment, the baby might have bilirubin encephalopathy, severe complications of neonatal
jaundice, sequelae such as cerebral palsy, high notes deafness, paralysis and dental dysplasia which greatly
affect quality of life.
To control the bilirubin level, the newborns should be given sufficient amount of liquid and calories
as early as possible, because then the motility of the intestinal tract will increase and also cause the
introduction of bacteria by which bilirubin was directly altered into urobilin and became unabsorbable. As a

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 The Differences in the Disappearance of Physiological Jaundice in the Newborns on Exclusive

result, the total serum bilirubin (TSB) could decerease (Bobak, 2004). The provision of adequate liquid can
help neonates meet the needs of glucose.The best food for newborns is breast milk because it has great benefits
for the neonates in the transitional period. Breast milk contains antibodies, carbohydrates, fats and vitamins.
Some of them like beta glucoronidase which functions to break down bilirubin into a soluble form in fat, so the
indirect bilirubin will increase and then will be reabsorbed by the intestinal tract.

General Purpose
To Know the differences of disappearance of physiological jaundice in newborns on exclusive breast-feeding
and non-exclusive breast-feeding.
Special Purpose
1. To identify the first day of the emergence of physiological jaundice in the newborns.
2. To identify the disappearance of physiological jaundice in the newborns.
3. To analyze the differences in the disappearance of jaundice in newborns with exclusive breast-feeding and
non-exclusive breast-feeding ones.
Research Benefits
1. The Theoretical Benefits
To broaden the theory of neonates-midwifery care, particularly in handling the physiological jaundice in the
newborn.
2. Practical Benefits
(1) To provide inputs to health care providers (health professionals) for the counseling materials to mothers
with infants for the purpose of encouraging them to breast-feed their babies frequently until the age of 6
months even though the baby suffers from physiological jaundice.
(2) To give inputs to other researcher to do further research with different methods and variables in infants
with jaundice.

Conceptual Framework

Figure (1) The conceptual framework of the research

Research Hypothesis
There are some differences in the disappearance of physiological jaundice in the newborns on exclusive breast-
feeding and non-exclusive breast-feeding.

II. Research Methods

Design
This research was a comparative study aimed to know the difference of disappearance of
physiological jaundice in infants with exclusive breast-feeding and non-exclusive breast-feeding, with cross
sectional approach. This research only observed the frequency and characters of the disease and exposure
factors in the population at certain point of time (Nursalam, 2008).
Population and Sample
The population of this study was mothers of newborns with physiological jaundice in Independent
Practice of Midwifery (BPM) in Patrang Sub-district, Jember district, East Java, Republic of Indonesia. The
total population was 60 people, 56 of whom met the criteria to be the samples based on the Slovin formula
(Nursalam, 2008).

Sampling Technique
To obtain the data, accidental sampling by which the available subjects were simply entered into the study
without any attempt at randomization was opted.

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 The Differences in the Disappearance of Physiological Jaundice in the Newborns on Exclusive

Research Variables and Operational Definitions

(1) Physiological jaundice emerges on the second day or the third day and has no basis in pathology or do not
have the potential to be pathological jaundice. The symptomps are as follows: a) appear in the second and
third day, b) the level of indirect bilirubin does not exceed 10 mg% in term neonates, c) the increasing
speed of bilirubin levels does not exceed 5% per day, d) direct bilirubin does not exceed 1 mg%, e)
Jaundice will disappear in the first 10 days, f) no symptoms related to pathological conditions.
(2) Exclusive breast-feeding means that the infants receive only breast milk from birth until the age of 0-6
months. No other liquids or solids are given such as formula milk, juice, tea water, honey and not even
water.
(3) Non-exclusive breast-feeding means that the infants receive both at the same time breast milk and
additional food like liquids or solids from birth until the age of 0-6 months.
Data Analysis
In bivariate analysis, independent t-test therefore was used to determine whether differences arose in the
disappearance of physiological jaundice in the newborn on exclusive breast-feeding and that of non-exclusive
breast-feeding.
III. Result
Table (1) Frequency Distribution of the Emergence of Physiological Jaundice in the newborns
No. Newborns on Exclusive Breast-feeding x % Mean SD
1. Day 2 9 34,6 9 34,6
2. Day 3 17 65,4 17 65,4
Newborns on Non-exclusive Breast-feeding
1. Day 2 9 30 9 30
2. Day 3 21 70 21 70

Table (1) indicated that in the newborns on exclusive breast-feeding, the physiological jaundice
appeared in day 2 as 34,6% and day 3 as 65,4%, while newborns on non-exclusive breast-feeding the
physiological jaundice appeared in day 2 as 30% and day 3 as 70%.On average, on day 1 the emergence of
physiological jaundice of newborns on exclusive breast-feeding was 2,65 days with deviation standard of
0,485,while for newborns on Non-exclusive Breast-feeding was 2.70 days with deviation standard of 0,466.
Table (2) Frequency Distribution of the Disappearance of Physiological Jaundice in the newborns
No. Newborns on Exclusive Breast-feeding x % Mean SD
1. Day 5 12 46,1
2. Day 6 10 38,4 5,77 0,051
3. Day 7 3 11,5
Newborns on Non-exclusive Breast-feeding
1. Day 5 1 3,3
2. Day6 1 3,3
3. Day 7 9 30 7,90 1,155
4. Day 8 11 36,7
5. Day 9 5 16,7
6. Day 10 3 10

Table (2) indicated that in the newborns on exclusive breast-feeding physiological jaundice
disappeared on day 5 as 46,1%, on day 6 as38,4%, on day7 as 11,5%, on day 9 as 3,8%, while for newborns
on non-exclusive Breast-feeding physiological jaundice disappeared on day 5 as 3,3%, on day 6 as 3,3%, on
day 7 as 30%, on day 8 as 36,7%, on day 9 as 16,7%, on day10 as 10%.
Table (3) The analysis of difference of physiological jaundice disappearance in the newborns on
exclusive breast-feeding and those of non-exclusive Breast-feeding
Breast Milk Provision Mean SD SE P Value 95% CI N
Exclusive 5,77 0,187 0,000 -2.703 26
Non-exclusive 7,90 0,051 0,211 -1.558 30
1,155

Table (3) indicated that physiological jaundice disappearance in the newborns on exclusive
breast-feeding on average was 5,77 days, while for newborns on non-exclusive breast-feeding 7, 90 days.
Independent t-test result showed p=0,000 which means that difference arose on physiological jaundice
disappearance between newborns on exclusive breast-feeding and that of non-exclusive breast-feeding. Of
newborns on exclusive breast-feeding physiological jaundice disappeared more quickly than that of non-
exclusive breast-feeding. Based on 95% of interval confidence value, it is believed that through exclusive
breast-feeding, physiological jaundice in the newborns will likely disappear faster.

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 The Differences in the Disappearance of Physiological Jaundice in the Newborns on Exclusive

IV. Discussion
Time of emergence of physiological jaundice in the newborns on exclusive breast-feeding and those of
non-exclusive breast-feeding
Research result indicated that the first emergence of physiological jaundice in the newborns on
exclusive breast-feeding was 2,65 days on average, while for those of non-exclusive breast-feeding
physiological jaundice appeared at 2,70 days on average. The result was in line with the theory of Risa et al
(2006) that physiological jaundice in the newborn was yellowish color on sclera and skin caused by
hyperbilirubin. At the initial stage, physiological jaundice appears in sclera (the white part of eyes) and face,
then spreads out in the cephalocaudal area (from the upper and lower part of the body) through chest, belly and
extrimity. Of the newborns, physiolgical jaundice does not normally visible on sclera as they generally cannot
open eyes. A large number of neonates experience indirect high level of bilirubin on the first day of life both
physiological and pathological jaundice. This happened due to physiologic process on neonates. The process
took place owing to high level of erythrocytes in neonates in which the lifespan of erythrocytes on neonates is
shorter than that of adults around 80-90 days and also due to undeveloped functions of liver. The high level of
bilirubin happened on day 2 or 3 and was on the peak on day 5-7, physiological jaundice appeared on day 2 or
3 of the newborns.

The Disappearance of Physiological jaundice in the newborns on exclusive breast-feeding and those of
non- exclusive breast-feeding
The research result indicated that the disappearance of physiological jaundice in newborns on
exclusive breast-feeding was 5,77 days on average and those of non-exclusive breast-feeding the
disappearance of physiological jaundice was 7,90 days on average. Of newborns on exclusive breast-feeding
bilirubin silted beneath the skin especially on sclera and face on day 2 and day 3 will likely disappear when the
newborn was exclusively breast-fed, direct bilirubin on the intestinal-tract will be tied up by food inside it and
will be released as sterkobilin together with faeces. Though newborns on exclusive breast-feeding may
experience jaundice, when usually breast-fed since birth date, they will obtain intake from cholostrum release,
so that direct bilirubin will be tied up by food and released through urine faeses. Baby with physiological
Jaundice who has yet consumed enough breast-feeding, no specific medication, even not fresh water, sugar and
formula milk; only breast-feeding actions needed more regularly, as baby is in need of it, at least eight times a
day by monitoring breast-milk sufficiency through urine observation (6-7 times a day) and faeces (3-4 times a
day).Thus, direct bilirubin will be tied up and released through urine and fesses until jaundice disappeared. The
newborns with physiological jaundice and on exclusive breast-feeding will likely undergo Jaundice
disappearance on day 9. This is due to the decrease of jaundice level to Kremer 2 (Behrman, 2000).Whereas, in
the newborns with physiological jaundice and on non-exclusive breast-feeding, their intestinal mucosa is not
coated with protein from cholostrum. This condition enables bilirubin to be easily reabsorbed by direct
intestine bilirubin and will be altered to be indirect bilirubin which will at the same time be reabsorbed into
blood to improve enterohepatic circulation. Baby with jaundice and on non-exclusive breast-feeding but still
consume other intakes, the breast-milk intake will be hampered or not optimal. As the result direct bilirubin
bond was not either optimal or will enable to prolonge jaundice disappearnce (Hegar,2008).

The difference of physiological jaundice disappearance between newborns on exclusive breast-feeding

and those of non-exclusive breast-feeding
From t-test result, the duration of jaundice disappearance of newborns on exclusive breast-feeding and
those of non-exclusive breast-feeding showed value of p=0,000 which means the physiological jaundice
disappeared more quickly to baby on exclusive breast-feeding than that of non-exclusive breast-feeding.
This is because after the delivery, the newborns directly undergo early breast-feeding initiation (IMD) or
provided with cholostrum which binds direct bilirubin that will be released through faeces or urine.
Furthermore, milk protein will coat intestinal mucosa so that direct bilirubin is not reabsorbed into bloodstream
and will be changed into indirect bilirubin. In the newborns with physiological jaundice and on non-exclusive
breastfeeding, although tend to obtain cholostrum, the addditional milk will hamper the process of breast milk
production as a result not all direct bilirubin bound by food will be released through faeses and urine. The
disappearance of physiological jaundice can be due to sun exposure (Etika, 2006).

V. Conclusion and Suggestion

Conclusion
The research concluded that the difference of physiological jaundice disappearance experienced by
Newborns on exclusive breast-feeding and those of non-exclusive breast-feeding shows up with the following
points:

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 The Differences in the Disappearance of Physiological Jaundice in the Newborns on Exclusive

1. On day 1, the appearance of physiological jaundice of babies on exclusive breast-feeding occured more
quickly than those of non-exclusive breast-feeding.
2. The disappearance of physiological jaundice of babies on exclusive breast-feeding occured more quickly
than those of non-exclusive breast-feeding.

Suggestion
Based on the research result, some suggestions need to be taken into consideration which might be useful for
those of medical practitioners as follows:
1. Mothers of babies with physiologican jaundice are hoped to keep exclusive breast-feeding. Normally, only
a little cholostrumruns, but with regular actions, breast milk will be produced faster and better in quantity.
Breast milk mixed with additional components will likely hamper the production of good breast milk.
2. Paramedics are hoped to provide prospective mothers and women with enough information on this issue
especially the benefit of exclusive breast-feeding. This is particularly important when their babies suffer
from physiological jaundice.

References
[1]. Behrman, et al., (2000), Ilmu Kesehatan Anak Nelson, Jakarta, EGC
[2]. Bobak et al., (2006), Buku Ajar Keperawatan Maternitas, Edisi 4, Jakarta, EGC
[3]. Etika, (2006), Hyperbilirubinemia in Neonatus, Surabaya: Fakultas Kedokteran Universitas Airlangga
[4]. Hasvivin, (2013), Pemberian ASI, Riwayat Asfiksia dan BBL dengan kejadian ikterus neonatorum, Penelitian.
[5]. Hasan, R, (2005), Inkompatibilitas ABO dan Ikterus pada Bayi baru Lahir in Buku Kuliah Ilmu Kesehatan Anak, Jakarta,
Salemba Medika
[6]. Hegar, e. Al., (2008), Bedah ASI, IDAI cabang DKI Jakarta; Jakarta
[7]. Nursalam, (2008), Metodologi Penelitian, Jakarta, Salemba Medika
[8]. Risa, E., et al., (2006), Hiperbilirubinemia pada Neonatus, Divisi Neonatologi bagian Ilmu Kesehatan Anak, FK Unair/RSU
Dr.Soetomo Surabaya, Available from, http://www.pediatrik.com.
[9]. Prawiriharjo, (2009), Buku Acuan Nasional Pelayanan Maternal dan Neonatal, Jakarta, Yayasan Bina Pustaka.

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