Breastfeeding And Jaunice: Is Breastfeeding My Baby Ruined?


Hello Mamas! Its me again bringing you another dynamic topic- jaundice in breastfeeding babies. I am sure most of you have heard about this topic before. For those of you who have not heard about it or do not know what it is about, I will give you the full brunt of it right in this post. After 34 years of nursing, working in the neonatal intensive care units, I has discovered that jaundice in infants is quite common.

What Is Jaundice?

Jaundice, a sign of elevated bilirubin levels, is common during the first weeks of life, especially among preterm newborns. Bilirubin, a product from the normal breakdown of red blood cells, is elevated in newborns for several reasons:

  • Newborns have a higher rate of bilirubin production due to the shorter lifespan of red blood cells and higher red blood cell concentration compared to adults.
  • Newborns have immature liver function, leading to slower metabolism of bilirubin.
  • Newborns may have a delay in passage of meconium, leading to increased reabsorption of bilirubin in the intestines.
  • In most newborns, jaundice is termed “physiologic jaundice” and is considered harmless.

Did you know that there are different types of jaundice?

Types of jaundice include:

  1. Normal newborn jaundice—happens naturally after birth.

Also known as physiological (normal functioning) jaundice, physiologic hyperbilirubinemia or icterus.

It is normal for a newborn baby’s bilirubin levels to rise after birth and then drop again during the first two weeks of life. In the first five days the levels of bilirubin in formula fed babies are the same as optimally fed breastfed babies 

2. Breast milk jaundice— or Breastfeeding Jaundice. Breast milk jaundice is unlikely to cause harm and the jaundice will gradually fade without treatment. However, prolonged jaundice can be an indication of serious liver disease or involve some other cause (Gartner, 2001). You can still breastfeed Mama. (PAID LINK)

EXCERPT FROM

Breastfeeding and Jaundice, Gartner, 2001

The full-term infant with breastmilk jaundice of less than 340 µM/L (20 mg/dl ) requires no intervention, and breastfeeding should be continued without interruption. For those full-term, healthy infants with breastmilk jaundice and serum bilirubin levels between 340 and 425 µM/L (20 and 25 mg/dl ), closer observation of bilirubin concentrations is indicated. Some clinicians may wish to observe, whereas others may choose to complement breastfeeding with formula for 24 to 48 hours, which will reduce intestinal bilirubin absorption, or initiation of phototherapy. When serum bilirubin concentrations rise toward 425 µM/L (25 mg/dl), the use of phototherapy while continuing breastfeeding, or the interruption of breastfeeding for 24 hours, substituting formula, may be indicated.

If a baby is poorly or premature the safe level for bilirubin may be lower and will require closer monitoring.

This is great news!

3. Starvation jaundice—insufficient calories increase the bilirubin pool. Breastfeeding or starvation jaundice can happen in the first few days of life or it can occur later in the newborn period, this is not “normal”. It is caused by not enough milk and it is the baby equivalent of adult starvation jaundice. Large amounts of bilirubin in meconium coupled with infrequent stools increase the serum bilirubin levels (levels in the blood) and further increase reabsorption of bilirubin in the intestines. A baby may have a combination of breast milk jaundice and starvation jaundice at the same time (Gartner 2001). This indicates the importance of getting breastfeeding off to a good start from birth with help from your IBCLC lactation consultant. When a baby gets plenty of colostrum and breast milk he will have plenty of poops (stools) and frequent poops help to lower the bilirubin levels. (PAID LINK)

4. Pathological jaundice—specific medical conditions cause or increase jaundice. A number of medical conditions can cause abnormal jaundice (see risk factors below). This type of jaundice usually appears within the first 24 hours after birth. It can also be combined with breast milk jaundice and/or starvation jaundice so, as above, it is still important to get feeding off to a good start with help from your IBCLC and see ABM Clinical Protocol #22, 2017.

One of the risk factors for abnormal jaundice is if there are certain incompatible blood types between mother and baby. Derby National Health Service (NHS) in the United Kingdom have a handout explaining more:

EXCERPT FROM

Jaundice in your Newborn Baby, Derby Hospitals, NHS [2017 accessed Oct 2019]

5.Rh incompatibility

If the mother’s blood group is negative( e.g. A-, B-, O-)and the baby’s blood group is positive, antibodies may be made by the mother to protect her against what the body recognizes as different cells. These antibodies invade the baby’s blood stream and surround his/her red blood cells causing them to break down. This is called ‘Hemolytic Disease of the Newborn’. It is usually prevented by screening during pregnancy and by the mother having an ‘Anti D’ injection to prevent the antibodies being produced.

ABO incompatibility

Different blood groups already have antibodies present. This means that if the mother’s and the baby’s blood group are different and they become mixed for some reason, the mother’s antibodies will break down the baby’s red blood cells, as happens with Rh incompatibility.

Both of the above conditions are usually diagnosed quickly, as your baby will become jaundiced within 24 hours of birth.

Different sorts of jaundice may occur at the same time. This can complicate things for baby as far as treatment is concerned.

Should I Continue breastfeeding?

Yes you can! Most newborns with jaundice can continue breastfeeding. More frequent breastfeeding can improve the mother’s milk supply and, in turn, improve caloric intake and hydration of the infant, thus reducing the elevated bilirubin. In rare cases, some infants may benefit from a time-limited, temporary interruption (12-48 hours1,2) of breastfeeding with replacement feeding to help aid in the diagnosis of breast milk jaundice. Ongoing clinical assessment, including repeat bilirubin levels, will help determine when breastfeeding can resume. (PAID LINK)

Further guidance is outlined in the Academy of Breastfeeding Medicine’s clinical protocols on supplementationexternal icon and jaundiceexternal icon. If temporary breastfeeding interruption is required, it is critical to help mothers maintain their milk production during this time. Your health professionals will keep an eye on bilirubin levels while breastfeeding continues and may carry out tests to rule out more serious causes of raised levels. They will advise if any treatment is needed should levels rise towards a certain threshold. Contacting an IBCLC lactation consultant if there are any problems with breastfeeding or milk supply will help avoid the possibility of getting starvation jaundice (see below) and breast milk jaundice at the same time.  The following paper from Gartner discusses the levels of bilirubin found in breast milk jaundice.

If I am at risk, what signs can I look for?

Vomiting & lethargy are some signs of jaundice!
  • You can observe your baby’s skin color for a yellow tinge
  • Observe your baby’s eyes for a yellow coloration
  • Fatigue- Your baby may look weak and fraile
  • weight loss
  • fever
  • vomiting
  • Presence of dark urine
  • pale stools are common.

Learn More

Sunning Your Baby Helps Reduce the levels of Bilirubin

Sunlight helps to reduce bilirubin levels!

“The practice of placing jaundiced infants under sunlight to reduce discoloration is a cultural health belief in most communities and appears to be effective in many anecdotal reports. In fact, midwives, nurses, doctors and pediatricians were identified to be the main professional sources of this belief [1]. In an in vitro experiment, it was found that sunlight was 6.5 times more effective than phototherapy in the isomerization of bilirubin compared to a phototherapy unit [2]. However, there are no appropriate controlled trials comparing the efficacy of sunlight to no treatment or artificial light therapy in jaundice [3]. Delayed treatment of severe jaundice in an otherwise healthy baby can result in the development of kernicterus – a complication causing brain damage as result of bilirubin deposition in the central nervous system [4]. Hence, withholding phototherapy would be unethical in controlled trials. We should not recommend sunlight for routine treatment of jaundice as this would encourage parental misconception that home therapy is adequate and result in delayed healthcare seeking behavior. Moreover, there are concerns of adverse effects of sunlight exposure causing skin tanning, sunburn and hyperthermia.” Neonatal Jaundice: To sun or not to sun? In our hospital in The Bahamas, we recommend putting baby in the sun for 15 minutes twice per day. This usually limits any harm to baby.

Learn More


Bottom Line:

Jaundice as you can see comes in different forms, however, it is great to know that your chances of breastfeeding your baby is high. When I worked in the hospital with the jaundiced babies , we always made sure that those babies were fed every 2 hours not 3 like with formula. Mamas, make sure you wake your baby if he/ she is sleeping. The bilirubin increases greatly when baby is low on calories. So make sure you give feeds every 2 hours. If you are breastfeeding, then baby can breastfeed anytime – less than 2 hours. Know also that God is with you. Always ask Him to help you. I wish wish you a safe, healthy, and happy breastfeeding journey. Stay inspired.(PAID LINK)

https://breastfeedingsuccessfully.home.blog

https://breastfeedingsuccessfully.home.blog

https://breastfeedingsuccessfully.home.blog

Check out this amazing video on Newborn Jaundice. Enjoy!