The Effect of Breastfeeding Support on Hospitalization Due to Jaundice
The Effect of Breastfeeding Support on Hospitalization Due to Jaundice
Neonatal jaundice is the most common reason for rehospitalization after postnatal discharge.
 Jaundice due to breastfeeding failure is an important subtype of pathological neonatal
 jaundice. Typically, it occurs with lactation failure, which results in dehydration (reducing
 urine output), significant weight loss (>10% of birth weight) and sometimes hypernatremia,
 during the first postnatal week. Jaundice caused by breastfeeding failure is observed in one
 third (31.8%) of total cases of pathological neonatal jaundice requiring rehospitalization.
 Jaundice lasts for an average of 6.8 days and the length of hospital stay takes up to 3 days.
 Jaundice due to breastfeeding failure requires focused efforts for a program structured with
 breastfeeding education and special breastfeeding support. This support causes the role of
 nurses to become even more important. The aim of this study is to investigate the effect of
 support provided for breastfeeding and the feeding of infants' with breast milk on
 hospitalization due to jaundice.

 Research Hypotheses:

 H0: The support provided for breastfeeding and the feeding of infants' with breast milk has
 no effect on hospitalization due to jaundice.

 H1: The support provided for breastfeeding and the feeding of infants' with breast milk
 affects the consequences of hospitalization due to jaundice.
Background: Neonatal jaundice is a condition that is accompanied by hyperbilirubinemia.
 Almost all newborns (60% term and 80% preterm) have more than 5mg/dl of bilirubin during the
 first week of life, and approximately 6% of term infants may have levels exceeding 15 mg/dl
 (Young Infants Clinical Signs Study Group, 2008). It is one of the most common causes of
 morbidity during the first week of life. High serum bilirubin level leads to serious
 consequences and neurologic disorders in some of the infants with jaundice. 5-10% of these
 newborns have clinically important neonatal jaundice that requires treatment and care to
 prevent neurotoxicity and reduce serum bilirubin level (Madan, Mac Mohan, Stevenson, 2005).
 Recent studies in the literature have shown that there is a strong relationship between
 hyperbilirubinemia and breastfeeding (Garg, 2018; Flaherman 2017). In a study, it was
 indicated that breastfed infants had lower bilirubin levels on postnatal day 3 compared to
 infants fed with infant formula. The problem of jaundice that increases due to insufficient
 intake of breast milk/breastfeeding is usually underestimated, an exaggerated physiological
 jaundice treatment is often administered (symptomatically phototherapy), and breastfeeding
 problems are neglected (Stark, Bhutani 2016). Therefore, while the infant and the mother try
 to adapt to each other for successful breastfeeding, the treatment process increases
 breastfeeding difficulties and failure during the first postnatal week. The role and
 counseling of the infant's nurse are of great importance in breastfeeding of the newborn and
 the education of the family in neonatal jaundice. The first postnatal hours and days are the
 most critical times for ensuring the success of breastfeeding. Jaundice due to breastfeeding
 failure requires focused efforts for a program structured with breastfeeding education and
 special breastfeeding support. This support causes the role of nurses to become even more
 important.

 Method: This is a randomized controlled experimental study. The data of the study will be
 collected from primiparous mothers who had normal delivery in the Gynecology and Obstetrics
 Department in Sakarya Maternity and Children's Hospital Campus affiliated to the Ministry of
 Health Sakarya University Training and Research Hospital between 01.08.2020-01.01.2021 and
 their infants until January 2021. The sample of the study was calculated in accordance with
 the intervention group selection criteria and by performing power analysis. Power analysis
 was performed using G*Power (v3.1.7) program in order to determine sample size. The effect
 range value was taken as 0.70 as the method used in cases where it is unknown how many units
 difference is significant between the groups. In cases where Type 1 error probability (α) was
 0.05 (at a confidence level of 95%), at a power level of 80% and the effect range was 0.70,
 the study was planned with a total of 68 mothers, including 34 mothers women for each group.
 The mothers to be allocated to the study and control groups will be ensured to have
 similarity in terms of three factors (age, educational status, gender of the infants). The
 individuals will be allocated into groups by simple random sampling. The sample of the study
 will be randomly allocated into two groups: the intervention group will be supported for
 breastfeeding and the feeding of infants' with breast milk, and the other group, which was
 the control group, will be followed in routine care of the service. Single-blind (researchers
 are not blind) randomization will be provided since the mothers will be provided with support
 for breastfeeding and the feeding of infants' with breast milk by the researchers. The
 statistician was also blinded for the data analysis purpose. With regard to data collection
 tools, the "Mother Introductory Information Form" including socio-demographic characteristics
 of the family, the "Newborn Introductory Information Form" including characteristic features
 of the infants, the "Infant Nutrition Follow-up Form" for the follow-up of breast milk milked
 after breastfeeding, and the "Jaundice Follow-up Form" including the follow-up of infants who
 are hospitalized due to jaundice before/after discharge will be used. Mothers in the
 experimental group will be provided with breastfeeding support, and if required, the mother's
 both breasts will be milked by hand and the resulting breast milk will be collected in a
 container. After milking, the milk will be given to the infant with the help of a teaspoon.
 This practice will be shown to the mother and will be performed after each feeding during the
 hospital stay. Mothers will be told to perform this practice at home until the infant sucks
 effectively and strongly, and families will be called by phone daily. No intervention will be
 made to the control group. Bilirubin measurements of both groups will be performed with a
 transcutaneous bilirubin meter both before discharge from the hospital and at the end of week
 1, and the values will be recorded. At the same time, the conditions of rehospitalization due
 to jaundice at the end of week 1 will be recorded. In the evaluation of data, statistical
 analyses will be performed using the SPSS package program. The Kolmogorov-Smirnov (K-S) test
 will be used for normality. In order to determine whether there is a difference in the
 dependent variables compared to independent variables, the independent group t-test will be
 used if the distribution is normal in independent variables with two options, and Mann
 Whitney-U test will be used if distribution is not normal. The results will be evaluated at a
 confidence level of 95% and at a level of significance of p<0.05.
Inclusion Criteria:

 -  • Normal delivery of the mother

 -  Mother being primiparous

 -  Newborn being >38 GW

 -  Having no multiple infants

 -  Absence of congenital anomaly (craniofacial abnormality such as cleft palate,
 cleft lip, paralysis of facial muscles) in the newborn

 -  No blood incompatibility between mother and father

 -  Exclusive breastfeeding of the newborn

 -  Non-contraindication of the mother's milk to her infant

 -  Absence of the mother's diagnosed psychiatric story

 -  Mother's openness to communication and cooperation

 -  Mother's volunteering to participate in the study

 -  Mother being literate

 -  Mother's age above 18 years

 Exclusion Criteria:

 -  • Separation of the mother and the infant due to any situation