生理性黃疸為新生兒出生面對的第一個常見短暫性問題，臨床上發現新生兒於出院後兩週再入院，以病理性黃疸為主要原因，而國內少有探討新生兒黃疸變化關係之研究；因此引發研究者欲探討，新生兒出生一週間之體重流失率、餵奶方式與黃疸變化的關係，期盼能讓醫護人員及家屬對黃疸有所認識，同時亦提供新生兒父母，合乎新生兒照護需求的護理指導。本研究目的為探討新生兒一週內之(1)體重的變化趨勢(2)餵奶方式與體重流失率之關係(3)黃疸的變化趨勢(4)餵奶方式與與黃疸之關係(5)體重流失率與黃疸之關係(6)體重流失率對黃疸的嚴重度預測性。
本研究採用描述性的研究設計，以南部某醫學中心及婦產科醫院出生的93位新生兒為研究對象，以非侵入性的經皮黃疸定測儀，測量出生後12、24、36、48、60、72、84、96、120、144、168小時共七日之膽紅素11次，並收集每日體重及餵奶方式。研究資料以描述性統計、皮爾森積差相關、單因子變異數分析、簡單回歸等進行資料分析。
研究結果發現（1）新生兒出生七天內，體重流失量及百分率到第四天達
最高峰，之後逐漸回升，第七天即接近出生時的體重。（2）一週內黃疸數值之
高峰時間，前額部位為出生120小時，而前胸部位為出生84小時。（3）三種餵奶方式，於新生兒出生第二、三、四天體重流失百分率，達統計上顯著差異，尤以出生第二、三天，哺餵純母奶之體重流失百分率最多；且第二天、第三天、第四天之體重流失百分率，哺餵純母乳者大於配方奶、哺餵純母乳者也大於混合奶。（4）新生兒以不同餵奶方式，於出生第一、二、五、六、七天，哺餵純母奶者，其新生兒黃疸指數均較高。（5）出生第二、三、四、五天體重流失百
I I
分率與120小時黃疸指數，有意義的正相關。出生第三、四、六天體重流失百分率與144小時黃疸指數，有意義的正相關。出生第二、三、六、七天體重流失百分率與168小時黃疸指數，有意義的正相關。（6）新生兒出生第二天體重流失百分率，來預測出生後96、120、168小時之黃疸指數，其解釋力分別6%、4.8%、6.3%，出生第三天體重流失百分率，對黃疸指數沒有預測力，出生第四天體重流失百分率，來預測出生後120、144小時之黃疸指數，其解釋力分別10.4%、5.6%；出生第五天及第六天之體重流失百分率，則無法預測其出生後144、168小時之黃疸指數。
本研究建議於住院期間哺餵純母乳之新生兒，需評估體重流失、黃疸指數及產婦哺乳相關問題，給予適時指導、協助或治療；未來研究方向為比較三種餵奶方式與體重流失百分率之差異性。

Physiologic jaundice is a common and transient problem for neonates after birth. However, pathologic jaundice is the major cause of readmission of neonates in two weeks after discharge. Thus, the issues of neonatal jaundice and the management are of importance. Few studies investigate relationships among the weight loss, feeding types, and jaundice of neonates in the first week of their life. Purposes of this study were to investigate: 1) the trend of the weight loss, 2) the trend of jaundice, 3) the relationships among weight loss, feeding types, and jaundice, and 4) the prediction of weight loss on the jaundice level of neonates in the first week of their life. A descriptive study was conducted. Ninety-three neonates born at a medical center and an obstetric hospital were enrolled. The transcutaneous bilirubin was measured with a noninvasive Bilicheck at 12, 24, 36, 48, 60, 72, 84, 96, 120, 144, 168 hours after birth. The body weight of the newborn was measured by an electrical scale daily. Data analysis was performed with Pearson correlations, student t-test, one way analysis of variance, and simple linear regression.
Result showed that in the first week of life, (1) neonatal weight loss reached the maximum on the fourth day and returned to the weight at birth on the seventh day, (2) the jaundice level measured at the forehead and upper chest reached its peak at 120 and 84hr respectively, (3) the highest percentage of weight loss is in the exclusive breast feeding group on the 2nd, 3rd , and 4th days, (4) the jaundice level were significantly higher on the 1st, 2nd, 5th, 6th, and 7th in the exclusive breast feeding group, (5) Percentages of weight loss on 2nd, 3rd, 4th, and 5th days were significantly correlated with the jaundice level at 120 hours. Percentages of weight loss on the 3rd, 4th, and 6th days were significantly related with the jaundice level at 144 hours. Percentages of weight loss on 2nd, 3rd, 6th and 7th days were significantly related
IV
with the jaundice level at 168 hours,(6) at 96, 120, and 168 hours after birth, 6%, 4.8%, and 6.3% of variance of jaundice levels were explained by the percentage of weight loss on the 2nd day respectively. At 120 and 144 hours after birth, 10.4% and 5.6% of variance of jaundice levels were explained by the percentage of weight loss on the 4th day respectively.
Results of this study show a small impact of the percentage of weight loss on the severity of jaundice. Exclusive breast feeding had a higher percentage of weight loss in the first week of life. Infants with exclusive breast feeding should be monitored with the weight loss and jaundice level.

李宏昌、楊俊仁、陳偉壽（2001）‧兒童營養學‧於黃富源主編，臨床兒科學（六 版，17-58頁），台北：嘉洲。
陳勃仲、陳睿俊、柯朝元（2007）‧淺談新生兒黃疸‧基層醫學，22（6），198-204。
彭純芝、許瓊心（2001）‧新生兒疾病‧於黃富源主編，臨床兒科學（六
版，235-248頁）‧台北：嘉洲。
鄧素文、高碧霞、蘇燦煮、楊雅玲（1995）‧探討兩種不同哺餵方式新生兒體重變化，護理研究，3（3），202-210。
鄧素文、何雪華、郭敏娟（1994）‧影響產婦哺母乳滿月時哺餵方式相關因素之探討‧護理研究，2（2），153-164。
Behrman, & Kilegman（1999）‧尼氏兒科學精要‧（李旺祚、顏大欽、陳慧玲、盧孟佑、葉樹人、黃妙慈等譯）‧台北：藝軒。（原著出版於1994）
American Academy of Pediatrics. (2004). Clinical practice guideline subcommittee on hyperbilirubinaemia: Management of hyperbilirubinaemia in the newborn infant 35 or more week of gestation. Pediatrics, 114(1), 297-316.
American Academy of Pediatrics, Committee on Practice and Ambulatory Medicine. (1997a). Pediatrician,s responsibility for infant nutrition. Pediatrics, 99(5), 749-750.
American Academy of Pediatrics, Work group on breastfeeding. (1997b).
Breastfeeding and use of human milk. Pediatrics, 100(6), 1035-1039.
Amerongen, R. H., Moretta, A. C., & Gaeta, T. J. (2001). Severe Hypernatremic dehydration and death in a breast-fed infants. Pediatrics emergency care, 17(31), 175-180.
Anand, S. K., Sandborg, C., & Robinson, R. G. (1980). Neonatal hypernatremic
64
associated with elevated sodium concentration of breast milk. Journal Pediatric, 96(1), 66 -68.
Anderson, D. M., Willian, F. H., Merkatz, R. B., Schulman, P. K., Kerr, D. S., & Pittard, W. B. (1983). Length of gestation and nutritional composition of human milk. American Journal Clinical Nutrition. 37, 810-814.
Auerbach, K. G. (2000). Evidence based care and the breastfeeding couple: Key
concerns. Journal of Midwifery and Women,s Health. 45(3), 205-211.
Augustine, M. C. (1999). Hyperbilirubinemia in the healthy term newborn. The Nurse Practitioner, 24(4), 24-41.
Berkowitz, C. D. (2000). Pediatrics: A primary care approach (2th ed., pp. 51-52). Philadelphia: W. B. Saunders Company.
Bertini, G., Dani, C., Tronchin, M., & Rubaltelli, F. (2001). Is breastfeeding really favoring early neonatal jaundice? Pediatrics, 107(3), 41-46.
Bhutani, V. K., Gourley, G. R., & Adler, S., Kreamer, B., Dalin, C., & Johnson, L. H. (2000). Noninvasive measurement of total serum bilirubin in a multiracial predischarge newborn population to assess the risk of severe hyperbilirubinemia. Pediatrics, 106(2), e-17.
Bhutani, V. K., Johnson, L. H., & Sivier, E. M. ( 1999). Predictive ability of predischarge hour specific serum bilirubin for subsequent significant hyperbilirubinemia in health term and new-term newborns. Pediatrics, 103(1), 6-14.
Bu’Look, F., & Woolridge, M. W., & Baum, J. D. (1990). Development of coordination of sucking, swallowing and breathing: Ultrsound study of term and preterm infants. Development Medicine and Child Neurology, 32, 699-678.
Chapman, J. J. (1985). Concerns of breast feeding mothers from birth to months. Nursing
Research, 34(6), 374-377.
65
Chen, H. L., Wang, Y. H., Tseng, H., & Chong, C. (2005). Neonatal readmission within 2
weeks after birth. Acta Paediatrica Taiwanica. 46(5), 289-293.
Chou, R. H., & Ezhuthachan, S. (2003). Management of hyperbilirubinemia in
newborns: Measuring performance by using a benchmarking model. Pediatrics. 112(5), 1264-1273.
Cooper, W. O., Atherton, H. D., Kahana, M., Kahana, M., & Kotagal, U. R. (1995). Increased incidence of severe breastfeeding malnutrition and hypernatremia in metropolitan area. Pediatrics, 96(5), 957-960.
Dewey, K. G., Heining, M. J., Nommsen, L. A., Peerson, J. M., & Lonnerdal, B. (1992). Growth of breast-fed and formula-fed infant from 0 to 18 month: The darling study, Pediatrics, 89(6), 1035-1041.
Dollberg, S., Lahav, S., & Nimouni, F. (2001). A comparison of intakes of breast-fed and bottle-fed infants during the first two days of life. Journal of American College of Nutrition, 20(3), 209-211.
Emmatt, G. A. (2004). Hyperbilirubinemia in the well nursery. Field guide to the normal newborn (2th ed., pp.69-76). Philadelphia: Lippincott Williams and Wilkins.
Escobar, G. J., Greene, J. G., Hulac, P., Kincannon, E., Bischoff, K., Gardner, M. N., et al. (2005). Rehospitalization after birth hospitalization: patterns among infants of all gestations. Archive Disease Childhood Fetal & Neonatal Edition, 90, F125-F131.
Evans, K. C., Evans, R. G., Royal, R., Esterman, A. J., & James, S. L. (2003). Effect of caesarean section on breast milk transfer to the normal term newborn over the first week of life. Archive of Disease in Childhood Fetal & Neonatal Edition , 88, F380-F382.
Faber, B. M., & Mill, J. F. (2003). Early intravenous nutrition for the prevention of
66
neonatal jaundice (Review). Cochrane Database of Systematic Review, 3, 1-6.
Flaherman, V. J., Ferrara-Assiamira, N, T., & Newman, T. B. (2008). Prediciting significant hyperbilirubinemia using birth weight. Archive of Disease in Childhood Fetal &Neonatal, 93, F307 - F309.
Geiger, A. M., Petitti, D. B.,& Yao, J. F. ( 2001). Rehospitalisation for neonatal jaundice : Risk factors and outcomes. Pediatrics Perinatal Epidemiol. 15, 352-356.
Grajeda, R., & Perez-Escamilla, R. (2002). Stress during labor and delivery is associated with delayed onset of lactation among urban Guatemalan women. The Journal Nutrition, 132(10), 3055-3060.
Hall, R. T., Simon, S. S., & Smith, M. T. (2001). Readmission breastfed infants in the first 2 weeks of life. Journal of Perinatology, 20(4), 432-437.
Harding, D., Cairns, P., Gupta, S., & Cowan, F. (2001). Hypernatremia: Why body weighing breast fed babies? Archive Disease of Childhood in Fetal Neonatal Edition, 85, F145-F148.
Harrus, M. C., Bernbarn, J. C., Polin, J. C., Zimmerman, R., & Polin, R. A. (2001). Development follow up of breastfed term and near term infants with marked hyperbilirubinemia. Pediatrics, 107(5), 1075-1087.
Hayes, G. (2000). The jaundiced newborn: Minimizing the risk. Patient Care, 34(2), 45-56.
IP, S., Chung, M., Kulig, J., O’Brien, R., Sege, R., Glicken, S. M., et al. (2004). An Evidence-Base review of important issues concerning neonatal hyperbilirubinemia. Pediatrics, 114(1), 130-153.
Kaplan, J. A., Sieglar, R.W., & Schmunk, G. A. (1998). Fetal hypernatraemia dehydration in exclusively breast-fed newborn infants due to maternal lactation failure. American
67
Journal of forensic Medicine & pathology, 19(1), 19-22.
Kerarney, M. H., Cronenwett, L. R., & Barrett, J. A. (1990). Breastfeeding problems in the first week postpartum. Nursing Research, 39(1), 90-95.
Keren, R., Bhutani, V, K., Luan, X., Nihtianova, A., & Schwartz, J. K. (2005). Identifying newborns at risk of significationt hyperbilirubinemia:A comparison recommended. Archive of Disease in Childhood, 90(4), 415-421.
Keren, R., Luan, X., Friedman, S., Saddlemire, S., & Cnaan, A. (2008). A Comparision of alternative risk-assessment strategies for significant neonatal hyperbilirubinemia in term and near-term infants. Pediatrics, 121(1), 170-179.
Kent, J. C., Mitoulas, L. R., Cregan, M. D., Ramsay, D. T., Doherty, D. A., & Hartman, P. E. (2006). Volume and frequency of breastfeedings and fat content of breast milk throughout the day. American Academy of Pediatrics, 117(3), e387- e395.
Kini, N., Zahn, S., & Werlin, S. L. (1995). Hypernatraemia dehydration breast-fed infants. Western Medline Journal, 94(2), 143-145.
Kraemer, H. C., & Theimann, S. (1987). How many subjects? Statistical power analysis in research. Newbury park, CA: Sage.
Kroeger, M., & Smith, L. J. (2004). Impact of birthing practices on breastfeeding: Protecting the mother and baby continuum. Sundbury, MA: Jones and Bartlett.
Kusuma, S., Aqrawal, S. K., Kumar, P., Narang, A., & Prasad, R. (2009). Hydration
status of exclusively and partially breastfed near-term newborns in the first week
of life. Journal Human Lactation, 25(3), 280-286.
Laing, I. A., & Wong, C. M. (2002). Hypernatraemia in the first few days: Is the
incidence rising? Archive Disease of in Childhood Fetal Neonatal Editon, 87(2),
158-162.
Lin, Y. J., JU, S. H., & Lin,C. H. (1993). The clinical application of transcutaneous
68
bilirubinometry in full-term Chinese infants. Acta Paed Sin, 34(2), 69-76.
Littleford, J. (2004).Effects on the fetus and newborn of maternal angalgesia and
anesthesia: Review. Obsterical and Pediatric Anesthesia, 51(6), 586-609.
Lodha, R., Deerari, A. K., Jatana, V., & Paul, V. K. (2000). Noninvasive estimation of
total serum bilirubin by multi-wavelength spectral reflectance in neonates.
Indian Pediatics, 37(3), 371-375.
Lucas, A., Lockton, S., & Davies, P. S. (1992). Randomized trial of a ready to feed compared with powdered formula. Archive Disease of in Childhood Fetal Neonatal Editon, 67, F935-F937.
Macdonald, P. D., Ross, S. R., Grant, L., & Young, D. (2003). Neonatal weight loss in
breast and formula fed infants. Archive Disease of in Childhood Fetal Neonatal
Editon, 88, F742-F746.
Macdonald, M.G., Seshia, M. M., & Mullett, M. D. (2005 ). Avery’s Neonatology
pathphysiology and management of newborn. (6 th ed., pp.413-444). Philadelphia:
Lippincott Williams & Wilkins.
Madan, A., Mac-Mohan, J. R., & Stevenson, D. K. (2006). Neonatal hperbilirubinemia.
In Taeush HW, Ballard RA, Gleason CA, eds. Avery’s Disease of the newborn. (8 th ed., pp.1222-1256). Philadelphia: WB Saunders.
Madlon-Kay, D. J. (2001). Home health nurse clinical assessment of neonatal
jaundice. Archive Pediatrics Adolesc Medline, 155(5), 583-586.
Manganaro, R., Mami, C., Marrone, T., Marseglia, L., & Gemelli, M. (2001).Incidence of
dehydration and hypernatremia in exclusively Breast-fed infants. The Journal of
Pediatrics, 139(5), 673-675.
Maisels, M. J., & Gifford, K. (1983). Breastfeeding weight loss and jaundice. Journal of
Pediatrics, 102, 117-118.
69
Maisels, M. J., Gifford, K., & Antle, C. E. (1988). Jaundice in the healthy newborn infant:
A new approach to an old problem. Pediatrics, 81, 505-511.
Maisel, M. J. (1992). Neonatal jaundice. Effective care of the newborn. New York: Oxford University Press.
Maisel, M. J. (1999). Jaundice. Neonatology: Path-physiology and management of the
newborn. (4 th ed., pp. 765-819). Philaelphia: Lippincott Williams& Wilkins.
Maisels, M. J. (2006). Neonatal jaundice. Pediatric in Review, 27(12), 443-453.
Maisels, M. J.,& Watchko, J. F. (2003). Treatment of jaundice in low birthweight infant. Archive Disease of Childhood Fetal Neonatal Edition, 88, F459-F463.
Maisel, M. J. (2006). What’s in a name? Physiologic and pathologic jaundice: The conundrum of defining normalbilirubin level in the newborn. Pediatrics, 118(2) 805-807.
Martin, C. R., & Coherty, J, P. (2004). Neonatal hyperbilirubinemia. In Cloherty JP, Eichenwald EC, Stark AR, eds. Manual of Neonatal care. (15 th ed., pp.185-221). Philadelphia: Lippincott Williams & Wilkins.
Mishra, S., Agarwal, R., Ashok , J. R., Deorari, A. K., & Paul, V. K. (2008). Jaundice in newborns. Indian Journal of Pediatrics, 75(1),157-163.
Morton, J. A. (1994). The clinical usefulness of breast milk sodium, Pediatrics, 93(5) 802-806.
Moyer, V., Ahn, C., & Sneed, S. (2000). Accuracy of clinical judgement in neonatal jaundice. Archives of Pediatrics & Adolescent Medline, 154(4), 391-394.
Neifert, M. R. (2001). Prevention of breastfeeding tragedies. Pediatr Clinicial Northern American. 48(2), 273-297.
Newman , T. B., Escobar, G. J., Gonzalez, V. M., Armstong, V. A., Gardner, M. N., & Folck, B. F. (1999). Frequency neonatal bilirubin testing and
70
hyperbilirubinemia in a large health maintance organization. Pediatrics. 104(5), 1198-1230.
Nommsen, L. A., Loveady, C. A., Heinig, M. J., Lonnerdal, B. L., & Dewey, K. G. (1991). Determinants of energy protein lipid and lactose concentrations in human milk during the first 12 month of lactation: The darling study. American Journal Clinical Nutrition. 53, 457-467.
Oddie, S., Richmond, S., & Coulthard, M. (2001). Hypernatraemic dehydration and breast feeding : A population study. Archive Disease Childhood Fetal & Neonatal Edition , 85, F318-F320.
Osborn, L. M. (1986). Management of neonatal jaundice. Nurse Practitioner, 11(4), 41-53.
Ozdogan, T., Iscan, M., Ellikcioglu, C., & Yildiz, E. (2006). Hypernatraemic dehydration in breast-fed neonates. Archives of Disease in Childhood, 91, 104.
Pados, B. F. (2007). Safe transition to home: Preparing the near-term infant for
discharge. Newborn and Infant Nursing Review. 7(2), 106-113.
Park, D. K., Montgomery, D., & Yetman, R. J. ( 2000). Perinatal conditions:Jaundice. Pediatric primary care. (2 th ed., pp. 1172-1216). Philadelphia: W. B. Saunders Company.
Rubaltelli,V. K., Gourley, G. R., & Loskamp, N. (2001). Transcutaneous bilirubin measurement : A multi-center evaluation of a new device. Pediatrics,107(5), 1264-1271.
Richmond, G., Brown, M., & Wagstaff, P. (2003). Using a home care model to monitor bilirubin levels in early discharged infants. Top Health Inform Manage, 24(1), 39-41.
Riordan, J., Gross, A., Angeron, J., Kurmwiede, B., & Melin, J. (200). The effect of labor pain relief medication on neonatal suckling and breastfeeding duration. Journal of
71
Human of Lactation, 16(1), 7-12.
Sandra, L. (2002). The basic of breastfeeding. Breastfeeding special care babies . (2 th ed., pp.1-22). London：Elsevier.
Schwobel, A., & Sakraida, S. (1997). Hyperbilirubinemia: New approaches to an old problem. Journal of Perinatal & Neonatal Nursing, 11(1), 78-102.
Semmekrot, B. A., De vries, M. C., Gerrits, G. P.,& Van wieringen, P. M. (2004). Optimal breastfeeding to prevent hyperbilirubinaemia in healthy term newborns. Nedline Tijdschr Geneeskd, 148(41), 2016-2019.
Stanley, I, P., Chung, M., Kulig, J., O’Brien, R., Sage, R., Glicken, S. et al .(2004). An Evidence base review of important issues concering neonatal hyperbilirubinemia. Pediatrics, 114(1), 130-153.
Stevenson, D. K., Fanaroff, A. A., Maisels, M. J., Young, B. W., Wong, R. J., Vreman, .J., Macmahon, J. R., et al. (2001). Prediction of hyperbilirubinemia in near term and term infants. Pediatric, 108(1), 31-39.
Tajir, G. K., Sulieman. H., & Badrinath, P. (2006). Intra-group different in risk factors for breastfeeding outcomes in a multicultural commuity. Joural Human Lactation, 22(1), 39-47.
Tarcan, A., Tiker, F., Vatandas, N, S., Haberal, A., & Gurakan, B. (2005). Weight loss hypernatremia in breast-fed babies: Frequency in neonates with non-hemolytic jaundice. Journal Pediatrics Child Health. 41(4), 484-487.
Van-Dommelen, P., Van-Wouwe, P., Breuning-Boers, J, M., Buuren, S, V., & Verkerk,
P. V. (2007). Reference chart for relative weight change to detect hypernatraemic
dehydration. Archives of Disease in Childhood, 92, 490-494.
Wang, A. C., Chen, S. J., Yuh, Y. S., Ming, Y., Lu, T. J., & Lee, C. M. (2007). Breastfeeding associated neonatal hypernatremic dehydration in a medication: A
72
Clinical investigation. Acta Paediatrica Taiwanica. 48(4), 186-190.
Wennberg, R. P., Schwartz, R., & Sweet, A. Y. (1966). Early verb delayed feeding of low birth weight infants: Effects on physical jaundice. Journal Pediatric, 68, 860-866.
Wharton, B, A., & Bower, B. D. (1965). Immediate or later feeding for premature Babies: A control trail. Lancet, 2, 969-972.
Wolf, M, J., Beunen, G., Casaer, P., & Wolf, B. (1997). Extreme hyperbilirubinaemia in Zimbabwean neonates: Neuro-developmental outcome at 4 months. Europen Journal Pediatr, 156(3), 803-807.
Woolride, M. W., Baum, J. D., & Drewett, R. F. (1980). Does a change in the composition of human milk affect sucking patterns and milk intake？Lancet, 2, 292-1294.
Wright, A., Rice, S., & Susan, W. (1996). Change hospital practice to increase the duration of breastfeeding. Pediatrics, 97(5), 669-675.
Yeung, C. Y. (1992). Neonatal jaundice in Chinese. Hong Kong Journal Pediatrics, 9, 233-250.
Zuppa, A, A., Sindico, P., Antichi, E., Carducci, C., Alighieri, G., Cardiello, V., Cota, F., Romqqnoli, C. (2009). Weight loss and in health term newborns in partial and full rooming-in. Journal of Maternal and Fetal & Neonatal Medlicine. 22(9), 801-