Jaundice and breastfeeding: Prevention and treatment

The diagnosis of jaundice can be frightening to parents, even though it is a very common condition in newborns. According to the Centers for Disease Control and Prevention, approximately 60 percent of full-term infants develop jaundice within several days of birth and the rate is higher in the preterm infant. Jaundice causes the skin and the white part of the eyes to turn a yellow color. It occurs when there is a build up of bilirubin (or yellow pigment) in the tissue, which comes from the breakdown of old red blood cells.  Bilirubin is predominantly cleared out of the body in stool and may build up if the baby is not taking enough feedings to have regular stools. Symptoms include lethargy, a high-pitched cry, and poor feeding. There are different types of jaundice, some of which are: physiologic, breastfeeding, and breastmilk jaundice.

Physiologic jaundice typically appears between one and five days after birth. It occurs because babies are not able to get rid of excess bilirubin effectively.  Preemies tend to be more prone to develop jaundice because their organs are not fully developed yet and they may not be taking in enough feeding to have regular stool patterns which helps get rid of the bilirubin.

Breastfeeding jaundice is due to mild dehydration. It can occur if babies aren’t getting enough fluids, most often because feedings are spaced too far apart or the babies are not nursing enough. This milk dehydration will cause the baby to have fewer stools. Approximately one in 10 breastfed infants suffer from breastfeeding jaundice according to the CDC.

Breastmilk jaundice is rare. It typically happens during the second week of life in breastfed babies, and can last two to three months. It is thought to be caused by certain components of breastmilk, and how they affect the elimination of bilirubin. According to the CDC, breastmilk jaundice occurs in about one in 200 babies. Unfortunately, there is no prevention for breastmilk jaundice.

Prevention

Much of both physiologic and breastfeeding jaundice can be reduced by the mother having established her milk volume and by the baby taking adequate amounts of breastmilk. Colostrum, or the first milk after delivery, acts as a laxative, which encourages the excretion of bilirubin. A few other ways breastfeeding can help resolve physiologic, breastfeeding, and breastmilk jaundice include:

Keep up your milk volume with frequent nursing and/or pumping. Take adequate amounts of fluid and rest as much as you can as this will help establish your milk volume. Feed your baby early and often, and make sure your baby is getting enough breastmilk. Typically newborns eat between 10 and 12 times each day. Keep track of your baby’s weight gain, wet diapers, and bowel movements.

Ensure your baby is latching correctly. Latching problems can interfere with the amount of breastmilk your baby receives. If you are having problems breastfeeding, talk with your healthcare provider or lactation specialist for help.

Treatment

Treatment will depend on a few things: The Mayo Clinic website and chief medical officer at Prolacta, David Rechtman, M.D., share treatments that may be used to lower the level of bilirubin in your infant’s blood:

The U.S. Department of Health and Human Services says it’s important to encourage continued breastfeeding if your baby is jaundiced since most parents of these infants will be fearful that continued breastmilk may result in more jaundice or other problems. They should be reassured this is not the case. Jaundice is a common condition, and most babies with jaundice will not need treatment, as it typically clears up in breastfed babies within two to three weeks. Your healthcare provider might suggest increasing the frequency of feedings until it goes away. And it will dissipate over time, as your little one’s liver becomes more efficient, and they continue to consume the recommended quantities of breastmilk. Your little one should recover fully with the right monitoring and treatment.

• How high are the bilirubin levels
• How fast the bilirubin level is rising
• Was your baby was born prematurely
• How old is your baby is
• Phototherapy – Phototherapy is the most common and effective way to manage jaundice and is both safe and painless for the baby. Phototherapy can be used while you continue to breastfeed. During this treatment, your baby is placed under special lighting. The light spectrum begins at 350 nanometers and goes to about 500, and the UV spectrum ends at 400 nanometers. While being treated, your baby will only wear a diaper and protective eye gear. Phototherapy can also be supplemented with the use of a light-emitting pad or mattress.
• Intravenous immunoglobulin (IVIg) – Jaundice may be related to blood type differences between mother and baby, which result in the infant carrying antibodies from mom that contribute to the breakdown of blood cells. Intravenous infusion of immunoglobulin, a blood protein that can reduce levels of antibodies, may decrease jaundice and lessen the need for an exchange blood transfusion. This treatment is rarely used.
• Exchange blood transfusion – This treatment involves the removal of small amounts of blood from the baby and the replacement of that with fresh blood from a donor. Typically, this is done multiple times, and only in a newborn intensive care unit.
• Plasmapheresis – This treatment is also used rarely and only when severe jaundice doesn't respond to other treatments. It involves “repeatedly withdrawing small amounts of plasma, diluting the bilirubin and maternal antibodies, and then transferring plasma back into the baby.” It is only preformed in a newborn intensive care unit.