Icterul neonatal: prevenție, identificare timpurie şi rolul educaţiei materne şi al practicilor de alăptare – minireview

Introduction

Neonatal jaundice, characterized by yellow discoloration of the skin and sclera due to elevated serum bilirubin levels, is a prevalent condition affecting newborns globally⁽¹⁵⁾. While mild jaundice often resolves spontaneously, severe cases can cause acute and chronic bilirubin encephalopathy, leading to permanent neurological damage if untreated⁽²¹⁾. Jaundice presenting within the first 24 hours of life is abnormal and requires urgent clinical evaluation and management (American Academy of Pediatrics, 2004)⁽⁴⁾. Effective prevention hinges on improving maternal knowledge and promoting optimal breastfeeding practices, which enhance milk supply, improve neonatal hydration, and facilitate bilirubin elimination⁽²³⁾. Early recognition and management are critical to preventing severe complications. Strengthening maternal health services by incorporating educational and awareness programs during antenatal care can empower mothers to identify jaundice early and seek timely medical intervention⁽¹⁴⁾. Demonstrations of proper breastfeeding techniques during antenatal visits are also essential to ensure adequate neonatal nutrition and hydration⁽¹⁸⁾. In conclusion, comprehensive maternal education combined with supportive breastfeeding practices constitutes a cost-effective strategy to reduce the incidence and severity of neonatal jaundice.

Maternal attitudes, knowledge and breastfeeding practices influencing neonatal jaundice outcomes

Maternal attitudes towards illness, entrenched preconceptions and limited or outdated knowledge about neonatal jaundice significantly impact timely healthcare seeking and preventive behaviors. Such factors often delay medical attention, putting newborns at risk for severe complications⁽¹⁾. A clear understanding of the risks, early signs and necessary care for neonatal jaundice is crucial for mothers to ensure prompt detection and intervention⁽⁶⁾. Breastfeeding practices, specifically initiation timing, frequency, duration, milk volume and proper latch, are closely linked to neonatal jaundice onset, with early and well-managed breastfeeding significantly reducing hyperbilirubinemia risk⁽¹²⁾.

Maternal confidence in breastfeeding emerges as a key determinant of breastfeeding duration; low confidence correlates with earlier cessation and increased jaundice risk⁽⁹⁾. The decision to breastfeed is multifaceted, influenced by personal factors (maternal age, education, income, infant-mother bonding) and environmental contexts such as social support, healthcare guidance, workplace policies and cultural attitudes⁽²²⁾. Educating mothers on breastfeeding techniques, including correct latch assessment through parameters like audible swallowing and nipple comfort, reduces feeding difficulties and jaundice risk^(12,16).

Global data indicate widespread gaps in maternal awareness of neonatal jaundice causes, symptoms and prevention, particularly in low- and middle-income countries (LMICs)⁽¹¹⁾. According to World Health Organization (WHO), early initiation of exclusive breastfeeding significantly reduces neonatal illness and mortality, yet many regions report suboptimal breastfeeding initiation rates⁽⁵⁾. Strengthening antenatal and postnatal education is essential to improve breastfeeding practices and reduce the burden of neonatal jaundice and associated morbidity and mortality worldwide⁽¹⁹⁾.

Maternal knowledge about neonatal jaundice: international and Sri Lankan perspectives

Multiple international studies have assessed maternal knowledge regarding neonatal jaundice, consistently revealing significant gaps that may impede timely recognition and care. A facility-based cross-sectional study in Ethiopia⁽⁸⁾ involving 380 mothers reported an overall knowledge level of only 39.2%, with variations by parity and delivery type, underscoring the need for enhanced educational interventions. Similarly, a cross-sectional study in China⁽¹¹⁾ found that less than half (45.4%) of mothers had adequate knowledge about neonatal jaundice. Notably, misconceptions were common regarding causes, diagnostic methods and the benign nature of breast milk jaundice, suggesting that targeted health education programs are essential.

In a hospital-based study in Iraq, Amer and Faris (2025)⁽³⁾ found that, while some mothers recognized signs of jaundice, most lacked awareness of warning signs and complications. Maternal education and urban residence correlated positively with knowledge levels, highlighting social determinants of health literacy. In Nepal, Huang et al. (2022)⁽¹¹⁾ reported that nearly half of the mothers had low knowledge, with only 22% demonstrating adequate understanding, emphasizing the need for antenatal education. A similar study by Hamed and Khalil (2019)⁽¹⁰⁾ in Iraq documented 88% of mothers having poor knowledge, with education and occupation significantly associated with awareness.

Focusing on Sri Lanka, Rodrigo and Cooray (2011)⁽²⁰⁾ observed that over 50% of postnatal mothers had low knowledge about neonatal jaundice, with sociodemogra­phic factors influencing awareness levels. Many mothers were unaware of serious complications such as mental handicap and neonatal death, although nearly half recognized phototherapy as a treatment.

Collectively, these studies highlight that maternal knowledge about neonatal jaundice remains insufficient across diverse settings. There is a pressing need to strengthen education during antenatal care, improve healthcare providers’ training, and enhance community-level awareness to reduce neonatal morbidity and mortality associated with jaundice.

Breastfeeding practices and their association with neonatal jaundice

Global and regional studies consistently highlight the critical role of breastfeeding practices in the prevention and management of neonatal jaundice. A large cross-sectional survey across 57 countries found that only 39% of infants were breastfed within one hour of birth, 49% received no prelacteal feeds, and just 28% benefitted from optimal early breastfeeding practices. This study emphasized substantial variability depending on childbirth location and underscored the importance of skilled delivery care, especially in public sector facilities, to improve early breastfeeding rates⁽¹⁹⁾.

Prospective cohort studies further demonstrated that delayed initiation, low frequency, short duration, insufficient milk volume and improper latch significantly correlate with neonatal jaundice. For example, in Thailand, Eksamut et al. (2025)⁽¹²⁾ observed that neonates developing jaundice commenced breastfeeding later (mean: 5.56 hours postpartum) compared to non-jaundiced infants (1.57 hours), had fewer than eight feeds per day (92% versus 1.1%) and shorter feeding durations. In Zimbabwe, Dhliwayo et al. (2025)⁽¹⁷⁾ found a statistically significant association (p=0.01) between delayed breastfeeding initiation and severe neonatal jaundice within the first week of life, supporting early breastfeeding as a protective factor.

Breastfeeding prevalence and exclusivity remain suboptimal in many settings. A cross-sectional study in Nigeria reported 93.8% breastfeeding initiation, but only 38.8% within 30 minutes of delivery, and 58.8% exclusive breastfeeding for six months. Mothers without breastfeeding problems were more likely to exclusively breastfeed, emphasizing the need for education on preventing breastfeeding difficulties⁽²⁾. Similarly, in rural India, only 30% and 10% of mothers exclusively breastfed infants up to four and six months, respectively, with suboptimal breastfeeding knowledge and practice evident⁽¹³⁾.

In the Sri Lankan context, research by Lokeesan et al. (2025)⁽⁷⁾ showed most primiparous mothers acknowledged breast milk as ideal for infants, yet nearly half were unaware of its benefits for mothers, signaling gaps in breastfeeding education. An additional study found a significant correlation between maternal knowledge and behavior regarding neonatal jaundice, underscoring the importance of integrated education efforts⁽²⁰⁾.

Collectively, evidence emphasizes promoting early initiation, frequent feeds, adequate duration and proper latch through targeted breastfeeding support and education to reduce neonatal jaundice risks and improve infant health outcomes.

Conclusions

The literature review focused on maternal knowledge of neonatal jaundice, breastfeeding practices, and their association with neonatal jaundice globally. Neonatal jaundice’s high prevalence and the frequent need for phototherapy represent significant international health concerns. Early maternal awareness is crucial to minimize or prevent neonatal jaundice and to promote the benefits of breastfeeding for both infants and mothers. Establishing breastfeeding with correct positioning and attachment is vital for neonatal health. Numerous international studies have documented low maternal knowledge regarding neonatal jaundice^(8,10) and reported suboptimal early breastfeeding practices and knowledge^(2,13). Furthermore, evidence confirms a strong association between delayed initiation of breastfeeding and the incidence of severe neonatal jaundice⁽¹²⁾. These findings highlight the critical need for targeted educational interventions to enhance maternal understanding and breastfeeding practices worldwide.

Autor corespondent: F.M.M.T. Marikar E-mail: faiz@kdu.ac.lk

CONFLICT OF INTEREST: none declared.

FINANCIAL SUPPORT: none declared.

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