Jaundice is the yellowish pigmentation of the skin and the white of the eyes due to the high levels of bilirubin in blood (hyperbilirubinemia). The increase in bilirubin concentration in blood may have several etiologies, some harmless and some pathological conditions.
- More than half of all newborns become jaundiced during the first week of life. It is usually due to the higher-than-normal amounts of red blood cells (RBCs) that during the first days after birth get broken down producing the yellow pigment bilirubin, which circulates in the blood. When the bilirubin arrives at the liver, it is changed into a form that can be transported to the intestines and from there, carried out of the body in the stool. However, a newborn baby’s liver may not be able to process bilirubin efficiently in the first days of life, so bilirubin levels increase in the circulation and the excess is deposited in the skin, muscles, and mucous membranes of the body, which then take on a yellowish or golden color. This physiological hyperbilirubinemia has low levels that rise slowly over the first three to five days, and is usually short-lived and harmless.
- Additionally, jaundice seems to occur more frequently and last longer in breastfed babies. Researchers are not sure why. It is speculated that there is a substance in mother’s milk that affects the way the body eliminates bilirubin. As a result, healthy breastfed babies (thriving infant) may still show signs of harmless jaundice (with low bilirubin levels) at two or three weeks of age.
- However, jaundice is also usually related to ineffective or deficient nursing in the first days of life. Newborns who nurse every hour or two have frequent stools, and this eliminates bilirubin from the intestines more efficiently. Therefore, deficiently fed babies will accumulate bilirubin due to reduced number of stools.
In the last two cases, babies with jaundice should be encouraged to nurse more often (at least 10 to 12 times in 24 hours or supplemented with expressed or banked human milk) and more effectively (check to see if baby is latched-on and sucking well) to reduce bilirubin levels as soon as possible. Check out this web page for more information on how to breastfeed effectively https://www.llli.org/breastfeeding-info/positioning/
- But occasionally jaundice is a sign of other, more serious health problems. When bilirubin levels are high at birth or in the first day or two of life, the jaundice may be related to other health problems (disease or premature-related). It’s important to identify these early, so that the underlying problem can be treated because high bilirubin levels may cause it to enter the brain and damage the nervous system.
When a baby appears jaundiced, the doctor may order a blood test to measure how much bilirubin is in baby’s blood. Physicians then consider two basic questions: Is the jaundice physiologic, meaning a result of the normal process of adjusting to life outside the womb, or is there another more serious cause? Are the levels of bilirubin in the blood high enough to cause harm?
Sometimes it’s the treatment of jaundice that presents challenges for new breastfeeding mothers and their babies. Physicians used to suggest that a mother stop breastfeeding for 24 to 48 hours and give her baby formula to see if this will bring down the bilirubin levels. It is clear today that interrupting breastfeeding can lead to an early weaning and a baby who is deprived of the many benefits of breastfeeding. There are other ways to treat bilirubin levels that are high or rising rapidly, ways that are less likely to cause problems with breastfeeding.
One option is phototherapy, special lights to break down the bilirubin that is stored in baby’s skin so that it can be eliminated more easily. The baby is placed under the “bili-lights” wearing just a diaper, with his eyes covered to protect them. The baby remains under the lights continuously for a day or two, although parents may remove the baby from the lights for feedings. Once the baby’s bilirubin levels begin to fall, the lights are no longer needed. One of the problems with phototherapy is that it interferes with mother and baby being together and interacting freely in the first days of life. So, if phototherapy is necessary, it is important to do everything possible to help a mother to continue to feel close to her baby and continue to breastfeed. When bilirubin levels are higher than 17 mg/dl it has been shown that interrupting breastfeeding without phototherapy has no effect, but on the other hand phototherapy in combination with breastfeeding reduced bilirubin levels (1).
- If you are still in the hospital, the phototherapy unit can be set up in your room, so that you can talk to your baby, touch her, and breastfeed her frequently.
- If the baby is hospitalized but you, the mother, are not, you can stay with your baby in the nursery.
- Your doctor can order a home phototherapy unit, so that your baby can receive the light treatment without being hospitalized.
- Your doctor can arrange for your baby to receive phototherapy using the Wallaby phototherapy unit. This is a fiberoptic blanket that wraps around the baby’s trunk and provides continuous light treatment. The baby’s eyes do not have to be covered, and you can hold and breastfeed your baby without interrupting the treatment.
Working With Your Doctor
There is no one “right” way to treat jaundice in a breastfed baby. The American Academy of Pediatrics suggests that pediatricians discuss several treatment options with parents. Here are some questions to consider:
- Is it necessary to treat the jaundice at this stage? Could we continue to monitor the baby’s bilirubin levels, encourage the baby to breastfeed more frequently or supplement with human milk (either expressed or banked human milk), and re-evaluate the situation in 24 hours?
- If phototherapy is needed, what can be done to keep mother and baby together and breastfeeding?
If a doctor suggests that you stop breastfeeding and give your baby formula, ask about using phototherapy to treat the jaundice while you continue to breastfeed. In most babies, jaundice is short-lived and harmless. For sure, there may be times when it is necessary to treat the jaundice, but in these situations, parents and health professionals should remember that frequent breastfeeding in the first days of life helps ensure successful breastfeeding in the weeks and months to come. The goal is a healthy baby who continues to breastfeed.
Give Plain Water or Glucose Water Supplements?
And last but not least, mothers are sometimes told that giving baby bottles of water or glucose water will help to “flush out” the jaundice. This is not true. Bilirubin is eliminated in baby’s stools. A baby whose tummy is filled with water or sugar water will nurse less often and thus is more likely to have problems with jaundice (1-3).
(1) Martinez JC et al. Hyperbilirubinemia in the breast-fed newborn: a controlled trial of four interventions. Pediatrics. 1993 Feb;91(2):470-3.
(2) Gartner LM. Neonatal jaundice. Pediatr Rev. 1994 Nov;15(11):422-32
(3) Catz C et al. Summary of Workshop: Early Discharge and Neonatal Hyperbilirubinemia. Pediatrics. 1995 Oct;96(4)