Jaundice and breastfeeding


Definition

Jaundice is a condition that causes the skin and whites of the eyes to turn yellow. There are two common problems that may occur in newborns receiving breast milk.

Alternative Names

Hyperbilirubinemia - breast milk; Breast milk jaundice; Breastfeeding failure jaundice

Causes

This EM Should be displayed at the top of the article section "Causes"

Bilirubin is a yellow pigment that is produced as the body recycles old red blood cells. The liver helps break down bilirubin so that it can be removed from the body in the stool.

It can be normal for newborn babies to be a little yellow between days 1 and 5 of life. The color most often peaks around day 3 or 4.

Breast milk jaundice is seen after the first week of life. It is likely caused by:

Sometimes, jaundice occurs when your baby does not get enough breast milk, instead of from the breast milk itself. This kind of jaundice is different because it starts in the first few days of life. It is called "breastfeeding failure jaundice," "breast-non-feeding jaundice," or even "starvation jaundice."

Breast milk jaundice may run in families. It occurs just as often in males and females and affects about a third of all newborns who get only their mother's milk.

Symptoms

Your child's skin, and possibly the whites of the eyes (sclerae), will look yellow.

Exams and Tests

Laboratory tests that may be done include:

In some cases, a blood test to check for glucose-6-phosphate dehydrogenase (G6PD) may be done. G6PD is a protein that helps red blood cells work properly.

These tests are done to be sure that there are no other, more dangerous causes of the jaundice.

Another test that may be considered consists of stopping breastfeeding and giving formula for 12 to 24 hours. This is done to see if the bilirubin level goes down. This test is not always necessary.

Treatment

Treatment will depend on:

Often, the bilirubin level is normal for the baby's age. Newborns normally have higher levels than older children and adults. In this case, no treatment is needed, other than close follow-up.

You can prevent the kind of jaundice that is caused by too little breastfeeding by making sure your baby is getting enough milk.

If breastfeeding is not going well, get help from a lactation consultant or your doctor as soon as possible. Babies born before 37 or 38 weeks most often need extra help. Their moms often need to express or pump to make enough milk while they are learning to breastfeed.

Nursing or pumping more often (up to 12 times a day) will increase the amount of milk the baby gets. They can cause the bilirubin level to drop.

Ask your doctor before deciding to give your newborn formula.

In some cases, if babies aren't able to feed well, fluids are given through a vein to help increase their fluid levels and lower bilirubin levels.

To help break down the bilirubin if it is too high, your baby may be placed under special blue lights (phototherapy). You may be able to do phototherapy at home.

Outlook (Prognosis)

The baby should recover fully with the right monitoring and treatment. The jaundice should go away by 12 weeks of life.

Possible Complications

In true breast milk jaundice, there are no complications in most cases. However, babies with very high bilirubin levels who do not get the right medical care can have severe effects.

When to Contact a Medical Professional

Call your health care provider right away if you are breastfeeding and your baby's skin or eyes become yellow (jaundiced).

Prevention

Breast milk jaundice cannot be prevented, and it is not harmful. But when a baby's color is yellow, you must have the baby's bilirubin level checked right away. If the bilirubin level is high, it is important to make sure there are no other medical problems.

References

Holmes AV, McLeod AY, Bunik M. ABM Clinical Protocol #5: peripartum breastfeeding management for the healthy mother and infant at term, revision 2013. Breastfeed Med. 2013;8(6):469-473. PMID: 24320091 www.ncbi.nlm.nih.gov/pubmed/24320091.

Lawrence RA, Lawrence RM. Breastfeeding infants with problems. In: Lawrence RA, Lawrence RM, eds. Breastfeeding: A Guide for the Medical Profession. 8th ed. Philadelphia, PA: Elsevier; 2016:chap 14.

Maisels MJ, Clune S, Coleman K, et al. The natural history of jaundice in predominantly breastfed infants. Pediatrics. 2014;134(2):e340-e345. PMID: 25049352 www.ncbi.nlm.nih.gov/pubmed/25049352.

Preer GL, Philipp BL. Understanding and managing breast milk jaundice. Arch Dis Child Fetal Neonatal Ed. 2011;96(6):F461-F466. PMID: 20688866 www.ncbi.nlm.nih.gov/pubmed/20688866.

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