Infant jaundice is a yellow discolouration of a newborn’s skin and eyes. It is a fairly common condition caused by an excess of bilirubin. In utero the baby has extra red blood cells to transport the oxygen he receives from his mother via the placenta. Once baby is born and breathing on his own these extra blood cells are no longer needed and they break down. Bilirubin is a yellow pigment that is a by-product of the breakdown process.
In the early days bilirubin is excreted by being bound to water-soluble proteins in the blood which are processed in the liver where bile takes them to the intestines and the bilirubin is excreted in the stools. The first stool, meconium, has a high concentration of bilirubin. If it is not eliminated quickly the baby starts to absorb bilirubin back into the blood stream. As the bilirubin levels rise in the blood stream it can enter the skin, muscles and mucous tissues causing the yellowing of the skin and eyes.
Breastfeeding early and often encourages the rapid elimination of the meconium stools and decreases the opportunity for the bilirubin to be reabsorbed. A study by Yamauchi & Yamanouchi (1990) showed a clear correlation between fewer breast feedings in the first 24 hours and rates of bilirubin levels over 14mg/dl on Day 6 (28.1% of the babies who fed two or fewer times compared with 0% of the babies who fed nine or more times).
Mild jaundice generally takes a few days to appear and the levels rise slowly usually peaking between day 3 and 5 at less the 12 mg/dl. Jaundice that appears within the first 24 hours, rises quickly, and reaches higher than 17 mg/dl in a full term baby is indicative of a more serious problem. Pre-term babies are at greater risk of brain injury from excess bilirubin. Safe bilirubin levels are determined individually based on gestational age, weight and baby’s overall health.
Mild jaundice usually resolves without treatment. Effective breastfeeding and adequate milk intake helps baby clear the bilirubin from the blood stream. Some babies will have mildly elevated bilirubin levels for as long as 15 weeks. In the past there was a belief that prolonged jaundice was caused by breastfeeding and weaning was often recommended. “The proven benefits of breastfeeding far outweigh any theoretical advantage of reducing mild to moderate levels of jaundice” Gartner & Lee 1999.
Because the majority of bilirubin (98%) is eliminated in the stools supplementing the baby with water or glucose water does not prevent jaundice or bring down bilirubin levels and should be avoided. Feeding the baby water with a bottle may compromise breastfeeding by causing the baby to feel full and by altering the sucking pattern. Water or glocose water supplementation puts baby at an increased risk of absorbing excess bilirubin back into the blood stream.
Treatment of severe jaundice may involve separation of mother and baby so that the baby can spend time under phototherapy lights and/or supplementation if baby has not been getting enough breastmilk. Both of these can be upsetting and discouraging to the mother. Resolving the high bilirubin levels is the most important issue and generally only takes a few days. Once the baby’s bilirubin levels are dropping resolving any ongoing breastfeeding issues can again be the focus.
Skin to skin contact between mother and baby, while baby is not under the phototherapy lights, can encourage the instinctive feeding behaviours. Leaning back in a semi-reclined positon with baby resting tummy down on mum’s chest is comfortable and comforting even if baby is asleep. As baby wakes she may shift herself into a feeding position.
If baby is not emptying the breast effectively breast compression may help her get more milk with less effort, which in turn will keep her more interested and actively nursing.
Mum may find pumping, while baby is having a phototherapy treatment, helps to stimulate her milk supply. The pumped milk can be used for supplementation if needed.
If you have any questions about breastfeeding and jaundice or any other issues please contact a La Leche League Canada Leader.