The Jaundiced Newborn

on January 22, 2014 in Breastfeeding, Jaundiced Breastfed Newborns

Many newborns develop jaundice, a yellow coloring of their skin and eyes in the first days and sometimes weeks after birth. Jaundice occurs when a baby’s bilirubin level increases in their blood to higher than normal.


Bilirubin comes from the breakdown of red blood cells.  Red blood cells live only a few days and when they are destroyed, bilirubin is produced.  Bilirubin is then processed through the baby’s liver and then excreted through their bowel movements.  When the baby is in the uterus, the mother’s body removes bilirubin, but once the baby is born, the baby needs to take over this process.  Because newborn babies’ livers are immature and are slow at processing the bilirubin, it is common for these levels to rise in the baby’s blood stream leading to jaundice.  This normal rise in bilirubin is referred to as “physiologic jaundice” and nearly half of all babies develop it.  Physiologic jaundice is typically seen around Day 2,3, or 4 and usually disappears by the end of the first week. Babies born before 38 weeks gestation usually develop jaundice and may take a bit longer to get rid of it because their livers are more immature than term newborns.  Newborns who are bruised during the birth process often develop higher bilirubin levels. Babies of Asian descent also often develop higher levels of bilirubin.


When physiologic jaundice in a term newborn is mild to moderate, parents and some doctors may worry about it, but it will not hurt the baby.  The best treatment is frequent nursing so that the bilirubin will be eliminated from the stools.  Colostrum and early breastmilk act like a laxative and help the baby stool more frequently and lower their bilirubin levels.


Some babies develop jaundice for other reasons.  One type of jaundice, called ABO incompatibility, occurs when the mother’s blood type is O and the baby’s blood type is A, B, or AB. In this situation, maternal antibodies cross through the placenta, breaking down more of the baby’s red blood cells causing higher levels of bilirubin after the baby is born.  One the first or second day of life, the bilirubin levels rise rapidly.  Less common incompatibilities can also cause higher levels of bilirubin and jaundice.  Babies who are have blood incompatibilities; usually need treatment with special lights, known as “phototherapy” to help destroy excess bilirubin along with frequent nursing. Babies usually stay under these lights for a few days with their eyes covered with a protective mask.  In rare cases, a blood exchange transfusion may be done to reduce a very high bilirubin level.


Babies, who are nursing poorly, or not at all, often develop higher levels of jaundice.  This is referred to as “lack of brestmilk jaundice”. This happens when the bilirubin stays in the meconium, the baby’s early stools, staying in the baby’s bowel longer than normal and then is reabsorbed back into the bloodstream.  In this situation, the baby may have lost around10% or more of his/her birth weight.  Getting more colostrum and breastmilk into the baby best treats this type of jaundice.  If an adequate amount of mother’s milk is not available, then formula may need to be used. In these cases, nursing more frequently and supplementing the baby expressed breastmilk can help lower the baby’s bilirubin levels.


Another type of jaundice, common only to breastfed newborns is known as “breastmilk jaundice”.  It occurs in about one third of all breastfed newborns and appears around the fifth day of life or later.  Breastmilk jaundice can last four to six weeks but in some breastfed infants, as long as eight to ten weeks.  When a baby is jaundiced for longer than the first week, breastmilk jaundice can be diagnosed by laboratory tests to rule out other forms of jaundice.  Breastfeeding need not be interrupted to make this diagnosis.


When a baby is jaundiced, the doctor may order blood tests to measure the level of bilirubin and determine if treatment is necessary.  If the baby was born at term and is otherwise healthy, many doctors will not order treatment unless the bilirubin levels is over 20 milligrams per deciliter.  Frequent nursings may be all that is necessary.  Usually when bilirubin levels are high, babies are hospitalized for phototherapy and some communities offer home phototherapy services.


There are some doctors who ask the mother to stop breastfeeding when their baby is jaundiced or may want to supplement the baby with formula or sugar water.  This is generally unwise, unless a baby has lost an excessive amount of weight.  If a baby has lost too much weight or is failing to gain weight after the 5th day of life, offering the baby expressed breastmilk is a better option. Also, studies have suggested that water supplements may actually increase bilirubin levels and may lead to early weaning.  Calling a halt to nursing, even temporarily, may make a mother wonder if her milk is really best for her baby.


Since the 1980’s, the American Academy of Pediatrics has recommended that term, healthy newborns over 72 hours of age with bilirubin levels below 20 milliliters per deciliter (or 340 micromoles per liter) should be nursed frequently, at least 8 times each 24 hours and receive no water supplements.