What diet is recommended for hyperbilirubinemia?

Dietary Management for Hyperbilirubinemia

For patients with hyperbilirubinemia, adequate caloric intake with frequent feedings is the most important dietary intervention, with breastfeeding encouraged at least 8-12 times per day for infants.

Dietary Recommendations by Patient Population

For Newborns with Hyperbilirubinemia

• Breastfeeding Support:

  • Encourage breastfeeding at least 8-12 times per day for the first several days 1
  • Avoid routine supplementation with water or dextrose water in non-dehydrated breastfed infants 1
  • Continue breastfeeding during phototherapy 1, 2
  • Ensure adequate intake by monitoring frequency of nursing, wet diapers, and weight loss 1

• Feeding Frequency:

  • Decreased frequency of breastfeeding (fewer than 7 times per day) is associated with higher bilirubin levels 1
  • Breastfeeding 9-10 times per day is associated with lower bilirubin concentrations 1
  • Poor caloric intake and/or dehydration can contribute to hyperbilirubinemia development 1

• Supplementation Guidelines:

  • If supplementation is necessary, use expressed maternal milk preferably 1
  • Formula supplementation should be avoided unless bilirubin concentrations approach exchange transfusion levels 1
  • Vitamin K1 (0.5-1.0 mg) should be administered intramuscularly to all infants on the first day of life 1
  • Vitamin D supplementation (400 IU/day) for breastfed infants consuming less than 28 ounces of formula daily 1

For Adults with Hyperbilirubinemia (e.g., Gilbert's Syndrome)

• Lipid Content:

  • Diets with higher lipid content (9% or more of energy intake) help maintain normal bilirubin levels 3
  • Low-lipid diets (0.6% of energy intake) can increase plasma bilirubin by 76% 3
  • Avoid extremely low-calorie diets, as fasting can exacerbate hyperbilirubinemia 3

• Carbohydrate Considerations:

  • High carbohydrate intake with minimal lipids can worsen hyperbilirubinemia 3
  • Normal daily variation in dietary composition is unlikely to cause significant changes in bilirubin levels 3

For Patients on Parenteral Nutrition

• Risk Factors:

  • Duration of parenteral nutrition is the most consistent risk factor for parenteral nutrition-associated conjugated hyperbilirubinemia (PNAC) 4
  • Overfeeding can exacerbate hyperbilirubinemia in patients receiving parenteral nutrition 4

• Management Strategies:

  • Transition to full enteral feeding when possible 4
  • Consider alternative lipid sources (fish oil vs. soy oil) 4
  • Monitor trace element preparations as they may affect cholestasis severity 4

Monitoring and Follow-up

• Regular monitoring of bilirubin levels based on risk assessment 2
• Schedule follow-up within 24-48 hours after discharge for newborns 2
• Continue bilirubin measurements until levels are clearly declining 2

Special Considerations

• G6PD deficiency can cause sudden increases in bilirubin levels and requires intervention at lower thresholds 1, 2
• Late preterm (34-36 weeks) and early term (37-38 weeks) infants have higher risk of breastfeeding difficulties and hyperbilirubinemia 1
• Phototherapy remains the primary treatment for significant hyperbilirubinemia, with diet as an adjunctive measure 5

Common Pitfalls to Avoid

• Interrupting breastfeeding during treatment of jaundice increases risk of early breastfeeding discontinuation 5
• Supplementing with water or dextrose water does not prevent hyperbilirubinemia or decrease bilirubin levels 1
• Overlooking the importance of frequent feeding in the first days of life 1
• Failing to recognize risk factors that may require more aggressive nutritional support (prematurity, hemolysis, G6PD deficiency) 1, 2

The evidence strongly supports that adequate nutrition with appropriate feeding frequency is crucial for managing hyperbilirubinemia, particularly in newborns. For adults with conditions like Gilbert's syndrome, maintaining adequate caloric intake with sufficient lipid content helps prevent exacerbations of hyperbilirubinemia.