Jaundice is a sign of high bilirubin levels that occurs in 60% of full-term infants and 80% of preterm newborn babies, commonly during the first week of life. Bilirubin is a by-product of the breakdown of old red blood cells in a newborn. The primary reasons for high levels are:
There are two types of jaundice associated with breastfeeding. Breastfeeding jaundice is the early onset of jaundice resulting from caloric deprivation and/or insufficient feeding. Increasing feeding patterns could help to prevent or treat this kind of jaundice, especially if the bilirubin level is rising.
Breast milk jaundice, on the other hand, sets in late and is associated with abnormalities in the breast milk itself. Breastmilk jaundice syndrome or prolonged jaundice does not need much therapy if the bilirubin concentrations stay below 270mumol/l in healthy full-term infants. Temporary interruption of breastfeeding may be indicated when the bilirubin concentration is above 270mumol/l or rising.
Breast milk jaundice develops after the first week of life and persists longer than physiologic jaundice with no particular identifiable cause. Breastfeeding jaundice manifests in the first few days of life, peaks over the next few weeks and disappears by week 3 of life. Infants afflicted with breastfeeding jaundice exhibit mild dehydration and weight loss in the first few days of life.
Bilirubin is a yellow pigment produced as the body recycles the old red blood cells. The liver is the organ which breaks down the bilirubin so that it is excreted from the body via the stool. It is normal for newborn babies to appear yellow between day 1 to day 5 of their life. The colour fades around day 3 or 4.
Breast milk jaundice is seen after the first week of life. While the cause isn’t entirely known, it is possible that substances in breast milk do not allow certain proteins in the baby’s liver from breaking down the bilirubin.
When the baby does not get enough of breast milk, it is called “breastfeeding failure jaundice” or “breast non-feeding jaundice” or even “starvation jaundice”. This condition occurs in the following circumstances:
Breast milk jaundice could run in families and most likely affects about one-third of all newborn babies that feed only on breast milk.
Breast milk jaundice treatment and breastfeeding jaundice treatment methods overlap and must be practised when bilirubin levels are below 20 milligrams (in full-term, healthy infants).
There are some techniques that should not be used as a treatment to decrease jaundice.
A lactation professional will observe the frequency of feedings to monitor if your baby is latching properly and the supply of breast milk is sufficient for the baby. A physical exam will be done to check the skin and the whites of the eyes, as these turn yellow if the baby has jaundice. The doctor can suggest several tests to measure bilirubin levels, complete blood count, blood smear to identify the shape of the cells, etc. These can help rule out more dangerous causes of jaundice. You may also, on rare occasions, be asked to stop breastfeeding for 24 hours and give your baby formula milk. This is done in order to check whether bilirubin levels drop.
There is no prescribed way to prevent jaundice from occurring, but the severity of it can be controlled.
Most newborn babies with jaundice can continue to breastfeed. As the frequency increases, milk production in the mother increases, helping the baby feed more and increasing the caloric intake and hydration of the infant. This helps lower the bilirubin levels. Increased feeding will also aid in the passing of meconium which will throw away the excess bilirubin present in the blood via the stool. Prolonged jaundice in breastfed infants owing to breast milk jaundice could lead to a temporary cessation of breastfeeding. However, it is recommended for mothers to maintain their milk production by expressing milk and combining it with a formula to feed the baby. This will aid in not disrupting the breastfeeding relationship and help the mother have a constant supply of milk.
Jaundice is common among newborn babies. The main aim should be to continue breastfeeding to establish the relationship and ensure that the mother’s supply of milk is maintained. Feeding must be stopped only if the doctor recommends so, and alternative methods to keep a constant supply of milk must be practised to avoid any interference in the breastfeeding relationship.