Newborn jaundice and breastfeeding: What you need to know

You'll learn about this rather common newborn condition, and how to deal with it, plus what to do (and what not to do) when it comes to treatment...

Soon after your little one is born, his health will be monitored quite closely by doctors and nurses at the hospital. One fairly common condition they look out for is jaundice.

Jaundice is quite normal in most newborns (occurring 2-3 days after birth), and only if it goes above the 'normal' range will medical staff intervene.

This condition is more common among babies who are breastfed, and lasts a bit longer too among them too, say medical experts.

In this article, we talk about the relationship between newborn jaundice and breastfeeding, how to handle it and more.

newborn jaundice and breastfeeding Newborn jaundice is quite common

What is newborn jaundice?

Jaundice is a yellowing of the skin and/or whites of the eyes, that is caused by higher bilirubin levels in a newborn's blood.

It is most obvious when you lightly press on a newborn's skin to drain away the red colour, and when you lift your finger, the yellowish tinge of the skin becomes clear.

Bilirubin is a yellowish substance the body produces when it replaces old red blood cells.

When your baby is still in your womb, your placenta removes bilirubin from your little one's body. However, after birth, your baby's liver takes over doing this job -- and it may take some time for it to do this properly.

Because of this, it is quite normal for a baby's bilirubin level to be a bit high after birth, and it is this that causes jaundice. Once your little one is a bit bigger and the red blood cell amounts diminish, with this, the jaundice usually subsides too, often 1-2 weeks after birth.

Usually, jaundice appears first on a newborn's face, moving down the body to the chest, tummy, arms and legs. This condition can be harder to detect in darker-skinned babies, and is best seen in natural light.

If your doctor suspects your little one has jaundice, then he/she will check your baby's bilirubin levels through a blood test, and recommend the best course of action accordingly.

What causes jaundice?

SingHealth presents the following causes of jaundice:

  • Some babies develop jaundice because of the breakdown of blood due to bruising during birth, or superficial blood clots on their head.
  • When a baby's blood group is different to his mother's, the mother's antibodies may attack the baby's red blood cells, resulting in jaundice.
  • Some babies have an inherited glucose-6-phosphate dehydrogenase (G6PD) deficiency that causes jaundice. G6PD is an enzyme in the body that helps red blood cells function normally.
  • Occasionally, little ones develop jaundice because of an infection of the urinary system or blood.
  • Jaundice lasting for more than two weeks could be due to an infection, abnormal bile ducts or a metabolic disease.
  • Prematurity (babies born between 34 to 36 weeks) can cause jaundice due to these babies' less mature liver.

Do keep in mind that in many babies, the underlying cause for jaundice might not be found.

Breastfed babies have a slightly higher tendency to develop jaundice - but this is no reason to discontinue breastfeeding.

Types of jaundice

1. Physiologic Jaundice

This is the most common type of jaundice among newborns, affecting up to 60% of full-term babies in their first week of life, says the American Pregnancy Association (APA).

It is caused by elevated bilirubin levels, as explained earlier in this article.

2. Breastmilk jaundice

This is jaundice that lasts after physiologic jaundice subsides, and is seen in full-term, breastfed babies. According to the National University Children's Medical Institute (Singapore), this type of jaundice typically occurs at 4 to 7 days of age and may last from 3 to 10 weeks.

While medical experts say there is no known cause for breastmilk jaundice, there are theories that it might be linked to a component of breastmilk that blocks the breakdown of bilirubin. This kind of jaundice tends to run in families.

Most newborns who have true breast milk jaundice (only 0.5% to 2.4% of all newborns) might experience another increase in their level of bilirubin at about day 14; however, these levels will gradually decline.

If your baby has breastmilk jaundice, please do not assume something is wrong with your milk and stop breastfeeding because of this. As long as your little one is nursing well and his bilirubin levels are monitored, serious complications are rare.

In the words of internationally renowned paediatrician and lactation expert Dr. Jack Newman, "Do not stop breastfeeding for breastmilk jaundice."

newborn jaundice and breastfeeding Continuing to nurse your breastfed baby with jaundice will help reduce bilirubin levels.

3. Breastfeeding jaundice (not-enough-breastmilk jaundice)

High levels of bilirubin or jaundice that linger on for longer than usual may occur when a baby is not getting enough breastmilk.

When a baby gets insufficient breastmilk, his bowel movements are less, causing the bilirubin that was in the gut to get reabsorbed into the bloodstream instead of leaving the body with the bowel movement, explains Dr. Newman.

This causes breastfeeding jaundice -- this is not related to breastmilk jaundice.

The reasons for this type of jaundice to emerge are due to one or a combination of the following:

  • an improper latch
  • the mother's milk taking longer than usual to "come in"
  • when the baby is given other substitues that interfere with breastfeeding
  • limitation of breastfeeding due to hospital routines

Quite clearly, the best way to avoid breastfeeding jaundice is to get breastfeeding established well, and early. If a baby has this type of jaundice, increased feedings and help from a lactation consultant to ensure baby is taking in enough milk will help resolve the condition quickly.

What to do about jaundice in the breastfed baby?

The APA recommends the following courses of action for breast milk jaundice and breastfeeding jaundice in the full term, healthy infant if bilirubin levels are below 20 milligrams:

  • Feedings should be increased to 8-12 times daily. This will result in more bowel movements, which will help get rid of the bilirubin.
  • A lactation consultant should work with the mum to ensure her little one has a good latch. An improper latch can impact the amount of breastmilk a baby drinks.
  • If a supplementation is needed to increase baby's intake, then using a lactation aid to give expressed breast milk or a mixture of breast milk and formula is the best way to not interrupt the breastfeeding relationship. Again, a lactation consultant can help with this.
  • It is very rarely that you need to stop breastfeeding to treat your baby's jaundice. However, if your baby's bilirubin levels go above 20 milligrams, then it is usually recommended that breastfeeding is stopped for 24 hours, along with phototherapy (to be discussed later in the article). This usually results in a dramatic drop in bilirubin levels, and after the 24 hours, you can start nursing again.
  • If the above treatment is needed, it's important that mums continue pumping to maintain their breastmilk supply. A lactation aid can be used to nourish baby during this time.
  • If phototherapy is needed, speak to your doctor about using fiber optic blankets. You can take these home and continue breastfeeding uninterrupted.

newborn jaundice and breastfeeding Ask your doctor about getting a fibre optic blanket to continue treating your baby at home.

Do NOT do the following for reducing jaundice in a breastfeeding baby

  • Supplementing with sugar water: This can make the jaundice worse by interfering with breastfeeding and can also delay the reduction of bilirubin levels.
  • Stop breastfeeding: This too can make the jaundice worse and can hinder a mum's effort to give her baby the best possible nutrition during his newborn days and beyond. Continuing breastfeeding is one of the best ways to decrease and eliminate jaundice.

newborn jaundice and breastfeeding Phototherapy involves the use of blue fluorescent lighting to reduce bilirubin levels.

Phototherapy or Bili lights: What is this?

When the need is determined by a doctor, Bili lights -- a type of light therapy (phototherapy) -- are used to treat newborn jaundice.

This therapy involves shining a blue fluorescent light on the baby's bare skin. According to MedlinePlus, "a specific wavelength of light can break down bilirubin into a form that the body can get rid of through the urine and stools" -- which is what phototherapy does.

If your baby has to undergo phototherapy, he'll be placed under the lights wearing just a diaper and his eyes will be covered to protect them from the bright light. He will also be turned often for even distribution of the light on his skin.

During phototherapy, doctors and nurses will carefully monitor your baby's progress by noting down his temperature, vital signs and response to the lights.

Sometimes, the lights may contribute to dehydration; if this happens, fluids may be given intravenously during the treatment.

Your baby's bilirubin levels will be monitored during phototherapy. Once they have dropped, the treatment is complete.

In the rare case that bilirubin levels rise very rapidly, a blood therapy exchange is conducted to lower these levels and prevent brain damage.

Myth-busting

You may get advice from well-meaning acquaintances (including in-laws, nannies, maybe even your own mother!) about how to reduce jaundice.

Please note the following common 'treatments' are ineffective, according to NUH:

  • Giving water or glucose feeds: this will not not lower the jaundice, and could even be harmful to your baby's health.
  • Exposure to sunlight:  Sunlight does not effectively reduce the jaundice. In fact exposing your newborn's delicate skin to sunlight could cause sunburn and dehydration.

Please consult a doctor immediately if:

  • Your baby develops jaundice during the first 48 hours of life, if the level of jaundice increases rapidly to involve the lower tummy and legs, or jaundice is still present after day 14 of life.
  • You have difficulty with breastfeeding, and baby does not pass adequate amount of stool and urine, and appears more jaundiced.
  • Your baby's stools turn cream-beige or chalky-white or if the urine is dark (tea-coloured), and baby continues to have jaundice after day 14 of life.

We hope you've found this article helpful. Let us know your thoughts on the topic of newborn jaundice and breastfeeding in a comment below.