NURSING
MOTHERS, INC.
Jaundice
Factsheet 22
What is Jaundice?
Jaundice is a term describing the yellowing of the skin and the whites
of the eyes due to an accumulation of bilirubin in
the fat tissues. It is evident, to some degree, in 50 - 70% of all
newborns. Recent
studies suggest that normal jaundice may even have benefits for the infant:
the bilirubin acts as an antioxidant, enabling the
body to better fight off infections.
What is bilirubin and how is it measured?
Newborns are born with more red blood cells than they need to live outside the womb. These excess cells are broken down by the infant's body into free iron and bilirubin. The bilirubin is a waste product; most of it must be excreted by the liver and eliminated in the infant's stool. Unexcreted bilirubin is reabsorbed into the baby's fat tissues, producing the yellow tinge.
Bilirubin levels are determined by taking blood samples, usually with a heel stick, and measuring how many milligrams of bilirubin are present per deciliter of blood (mg/dl). Extremely high levels are known to cause kernicterus, a medical condition associated with brain damage.
Types of Jaundice
Physiologic, early onset, or normal newborn jaundice is the most common type of jaundice. It occurs because an infant's liver is immature and cannot clear the bilirubin as quickly as it is being produced. Normal newborn jaundice usually develops between the second and fifth days of life. Most newborns exhibit some degree of physiologic jaundice; it can become more evident if the baby is not getting enough breastmilk. A baby who is unusually sleepy and does not nurse long or often enough, or is given water bottles instead of breastmilk, may not produce enough stools to remove the bilirubin at normal rate.
Pathologic jaundice in a newborn often appears within the first 24 hours of life and is marked by a rapidly rising bilirubin level. It can result from abnormal breakdown of red blood cells, an abnormal metabolism, or abnormal clearance of bilirubin. This is the form of jaundice associated with kernicterus. If a newborn has pathologic jaundice, the doctor will usually search for an underlying illness in the baby or other possible causes, including blood incompatibility with the mother, infections, medications or drug use.
Late onset jaundice, often misnamed breastmilk jaundice, occurs in a very small percentage of breastfed infants. It begins to appear between the fifth and tenth days of life and may last for up to ten weeks. Some research suggests that a component in the breastmilk interferes with the liver enzyme necessary to aid excretion of the bilirubin. Because there is no laboratory test for late onset jaundice, a doctor will often ask a mother temporarily to stop breastfeeding to confirm the diagnosis. When a mother's breastmilk is removed from the baby's diet for one or more feedings, the bilirubin levels drop quickly. In most cases, once other possible causes of jaundice have been ruled out breastfeeding can resume. It is possible for an infant to have more than one type of jaundice, the combination of which can lead to exaggerated bilirubin levels.
Common Treatments
· Increased Nursing Early and frequent nursing is the best way to minimize normal newborn jaundice. A newborn typically needs between 8 and 12 feedings in a 24 hour period. Nursing as soon as possible after birth and frequently thereafter promotes stooling and helps the baby eliminate the excess bilirubin. Further treatments may not be necessary.
· Phototherapy Bilirubin is broken down easily by ultraviolet light. Doctors sometimes recommend exposure to sunlight for very mild cases of jaundice. In the hospital, bili-lights placed over the isolette are the most common form of phototherapy, but bili-blankets are gaining popularity. These blankets make it possible for a baby to receive phototherapy at home, wrapped in the fiber-optic blanket, which allows the baby to be held and breastfed. This warm environment, however, tends to be dehydrating. Also, warmth coupled with jaundice tends to make some babies very sleepy. It can be difficult to rouse them for feedings. It is important to encourage the baby to nurse 8 to 12 times during a 24 hour period. Be persistent. Diaper changes, cool washcloths on the forehead, uncovering the feet, and switching breasts as soon as sucking slows down are some techniques that have helped many mothers. Frequently switching breasts (about every 5 to 10 minutes, at least twice on each breast) is particularly beneficial, as it encourages milk production.
· Supplemental Formula Some doctors ask mothers to supplement with formula in order to increase the baby's stooling, though pumping and feeding expressed breastmilk after a nursing is usually a perferable alternative option. The formula can be given after nursing, provided the doctor has not eliminated breastmilk. If at all possible, avoid using a bottle to supplement; using a bottle nipple before nursing has been well established may cause the baby to later reject the breast.
· Supplemental Water While doctors routinely used to prescribe supplemental water to prevent dehydration, more recent studies show it is not beneficial. Water is non-nutritive and does nothing to promote the stooling essential for the removal of bilirubin. It can lead to a further decrease in the baby's appetite, increasing the amount of bilirubin reabsorbed into the baby's body. Frequent breastfeeding, on the other hand, provides both the increased fluids and the increased calories essential for the baby's recovery.
What if your doctor wants you temporarily to stop breastfeeding?
Ask your doctor how long she wants you to stop breastfeeding and why she feels it is important to do this. Let her know you would like to resume breastfeeding quickly, if it is possible to do so. Some doctors want to determine how much milk the baby is getting. If this is the case, giving the baby pumped breastmilk might be an acceptable compromise. If your doctor suspects late onset jaundice and wishes to confirm this diagnosis, she will want to observe the bilirubin levels after several formula feedings. In either case, you need to maintain your milk supply using a good electric breastpump. You can save the milk you pump for later use. Discuss alternatives to bottle-feeding with your care providers, since some babies are reluctant to return to the breast after getting used to a bottle nipple.
What is best for your baby?
Each baby's therapy can follow a different course, depending on the bilirubin level in relation to the infant's age, maturity, and underlying cause of the jaundice. Only your doctor and you know your baby's complete medical history and can make a judgment about how best tot treat the condition. We encourage you to discuss these issues with your doctor and explore options that best suit your baby's needs. Your Nursing Mothers counselor will be happy to lend assistance, whichever course you choose.
For more information on jaundice, visit the
following link to Dr. Jack Newman’s website:
http://www.bflrc.com/newman/breastfeeding/jaundice.htm
Revised: 9/94, Liz Connolly; 1/03, Megan Allen
Copyright on the Internet 1999, NMInc.
Nursing Mothers, Inc. is a
non-profit organization. We never charge for our
services, we would gladly accept your tax-deductible donations.
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