Newborn Jaundice and Breastfeeding: What You Need to Know

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

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

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

This article discusses the relationship between newborn jaundice and breastfeeding, how to handle it, and more.

What Is Newborn Jaundice

Jaundice is a yellowing of the skin and/or whites of the eyes, 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 overdoing this job -- and it may take some time 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, jaundice usually subsides too, often 1 to 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 more brutal to detect in darker-skinned babies and is best seen in natural light.

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

Is Jaundice in Newborns Common

It’s normal to be worried when your newborn has jaundice. After all, it can mean that there are complications with their liver, which can be serious. However, this condition is quite common and does not necessarily mean anything is wrong.

When babies are born, they have immature livers that cannot make bile to help break down your body’s waste products as quickly as yours can. This means that the toxins in your blood might stay in their systems longer than in an adult's. This is why newborns often have jaundice—their skin turns yellowish-orange because too many bilirubin molecules are building up in their bloodstream.

Parents need to know that most newborns will get jaundiced during the first week of life. Still, this condition doesn’t typically cause concern unless it lasts more than two weeks after birth or if the baby has symptoms like pallor (a pale colour), lethargy (sluggishness), irritability (irritability), anorexia (refusal/difficulty eating), vomiting, dark urine or clay-coloured stools.

How Long Will Jaundice Last in Newborn

Jaundice is a condition that causes your newborn's skin and eyes to appear yellow. It's common in newborns, especially those born prematurely or with low birth weights. Most babies develop jaundice within the first 24 hours of life.

In most cases, jaundice will go away on its own without any treatment. But in some cases, your doctor may recommend treating jaundice with light therapy (phototherapy).

When Will Jaundice Go Away in Newborn

It depends on your baby's age and how severe the jaundice is. For example: if your baby has severe jaundice, it might take a few days to improve; but if they have mild jaundice, it could go away much more quickly!

In most cases, jaundice goes away within two weeks of birth. However, if your newborn has severe jaundice and it doesn't go away on its own within two weeks of birth, it's time for a trip to the paediatrician—you may need an evaluation or treatment.

Causes of Jaundice in Newborn

Try yellowish eyes and skin brought about by jaundice may be attributed to the following factors:

• Some babies develop jaundice because of the breakdown of blood due to bruising during birth or superficial blood clots on their heads.

• When a baby's blood group differs from 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 usually.

• Occasionally, little ones develop jaundice because of an infection of the urinary system or blood.

• Jaundice lasting more than two weeks could be due to an infection, abnormal bile ducts or a metabolic disease.

• Premature delivery (before 36 weeks) can cause jaundice due to these babies' less mature livers.

Remember that in many babies, the underlying cause for jaundice might not be found.

Types of Newborn Jaundice

1. Physiologic Jaundice

This is the most common type of jaundice among newborns, affecting up to 60 per cent 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 newborn jaundice lasts after physiologic jaundice subsides and is seen in full-term, breastfed babies. According to the National University Children's Medical Institute (Singapore), this jaundice typically occurs within 4 to 7 days 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 breast milk that blocks the breakdown of bilirubin. This kind of jaundice tends to run in families.

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

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

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

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 breast milk.

When a baby gets insufficient breastmilk, his bowel movements are less, causing the bilirubin 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 substitutes that interfere with breastfeeding
• limitation of breastfeeding due to hospital routines

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

Newborn Jaundice and Breastfeeding

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

• Feedings should be increased to 8 to 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 breast milk a baby drinks.

• Suppose supplementation is needed to increase the baby's intake. In that case, using a lactation aid to give expressed breast milk or a mixture of breast milk and formula is the best way not to interrupt the breastfeeding relationship. Again, a lactation consultant can help with this.

• You rarely 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; after 24 hours, you can start nursing again.

• If the above treatment is needed, mums must continue pumping to maintain their breastmilk supply. A lactation aid can be used to nourish the baby during this time.

• If phototherapy is needed, speak to your doctor about using fibre-optic blankets. You can take this home and continue breastfeeding uninterrupted.

How to Reduce Jaundice in Newborn

Jaundice is a common problem in newborns. It is caused by excess bilirubin in the baby's body and can be treated with special lights and sometimes medication. Here are some tips for reducing the risk of jaundice in your newborn.

• Feeding Schedule

You should consider feeding your baby every three hours around the clock until their first birthday. You should also make sure that you burp them after each feeding and that they are burped at least five times a day, but no more than 15 times a day. This will help to reduce the amount of bilirubin that builds up in their system.

• Intravenous immunoglobulin

Intravenous immunoglobulin or IVIG works by containing antibodies that help eliminate harmful substances from your baby's bloodstream.

These antibodies can help reduce the amount of bilirubin (the substance that causes jaundice) in your baby's blood by binding with haemoglobin molecules and removing them from circulation. This will help reduce jaundice symptoms like itching and fussiness.

• Exchange transfusion

An exchange transfusion involves taking blood from the baby's body and replacing it with donor blood that has been heated to increase its oxygen-carrying capacity. The new blood improves the flow of red blood cells throughout the body and helps reduce bilirubin levels in the bloodstream and tissues.

• Phototherapy

Phototherapy uses specialised lamps that emit light at specific wavelengths, which helps to break down bilirubin into its components (heme and biliverdin).

This process is called photosensitisation, and it occurs when bilirubin absorbs energy from the light source. The absorbed energy causes the biliverdin to be converted into heme, which is then excreted by the kidneys.

Phototherapy or Bili lights: What is This?

When a doctor determines the need, 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" 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 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 rapidly, a blood therapy exchange can lower these levels and prevent brain damage.

How to Prevent Jaundice in Newborns

Are you worried about your baby developing jaundice? Here are some steps you can take to prevent it from happening:

1. Keep your child warm. Jaundice happens when your child doesn't have enough vitamin B6 in their system, which causes them to retain too much bilirubin—the yellow pigment that gives jaundiced babies their colour. The best way to keep your child's body temperature up is to dress them appropriately for the weather. Wrap them up tightly when you're outside.
2. Breastfeed or bottle-feed often. Breastfeeding can help reduce the chances of jaundice because it stimulates your body to produce more red blood cells—which help carry excess bilirubin from your baby's system. If breastfeeding isn't an option for you or if you need an alternative feeding method, try using formula instead of regular milk (even though it doesn't contain as much vitamin B6).
3. Keep your baby in a well-lit room for at least two hours daily.
4. Avoid dressing your baby in too many layers of clothing, as this will trap heat and cause your little one's skin to become overheated and yellow.

Newborn Jaundice and Breastfeeding

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

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

• Giving water or glucose feeds will not lower jaundice and could even harm your baby's health.
• Exposure to sunlight: Sunlight does not effectively reduce jaundice. Exposing your newborn's delicate skin to sunlight could cause sunburn and dehydration.

Avoid Doing the Following To Reduce Jaundice in a Breastfeeding Baby

• Supplementing with sugar water can make jaundice worse by interfering with breastfeeding and delaying the reduction of bilirubin levels.
• Stop breastfeeding: This too can make jaundice worse and 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.

When to Consult a Doctor for Newborn Jaundice

While most cases of jaundice resolve on their own, there are certain signs that indicate it's time to seek medical attention. Here are five signs that should prompt you to consult a doctor if your newborn has jaundice.

1. Yellowing of the Skin and Eyes: If you notice a yellow tint on your baby's skin or the whites of their eyes, it could be a sign of jaundice. While mild yellowing is common in newborns, a deep or worsening yellow colour may indicate elevated bilirubin levels requiring medical evaluation.

2. Changes in Feeding Habits: Jaundiced babies may show signs of decreased appetite, difficulty latching or sucking during breastfeeding, or reduced frequency of wet diapers. If you notice significant changes in your baby's feeding patterns, it's advisable to consult a healthcare professional.

3. High-Pitched Crying or Irritability: Excessive crying, particularly if it's high-pitched or different from your baby's usual cries, can be an indication of jaundice. Newborns with high bilirubin levels may become fussy, irritable, or difficult to console. If your baby's crying seems abnormal, don't hesitate to seek medical advice.

4. Unusual Stool Color: Babies with jaundice may have pale or clay-coloured stools instead of the typical yellowish mustard-like stool seen in healthy infants. Keep an eye on your baby's diaper changes, and if you notice any significant deviations in stool colour, it's time to reach out to your healthcare provider.

5. Extreme Sleepiness or Lethargy: While newborns sleep a lot, excessive sleepiness or difficulty waking your baby for feeding may be a cause for concern. If your baby appears unusually sleepy, unresponsive, or difficult to wake up, it's important to seek medical attention promptly.

6. Prolonged Jaundice: While most cases of newborn jaundice resolve within a couple of weeks, prolonged jaundice refers to jaundice that lasts beyond the expected duration. If your baby's yellowing of the skin and eyes persists for more than two weeks, it's important to consult a doctor. Prolonged jaundice could be a sign of an underlying condition that requires medical evaluation and appropriate management.

Remember, these signs may vary from one baby to another, and the severity of jaundice can also vary. If you have any concerns about your baby's health, it's always best to consult a healthcare professional for a proper diagnosis and appropriate treatment.

Updated by Pheona Ilagan

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