Jaundice, a sign of elevated bilirubin levels, is common during the first weeks of life, especially among preterm infants. Bilirubin, a product of the normal breakdown of red blood cells, is elevated in newborns for several reasons:

  • Newborns have a higher rate of bilirubin production due to the shorter lifespan of red blood cells and the higher concentration of red blood cells compared to adults.
  • Newborns have immature liver function, leading to slower metabolism of bilirubin.
  • Newborns may have a delay in the passage of meconium, leading to increased reabsorption of bilirubin in the intestines.
  • In most newborns, jaundice is called “physiologic jaundice” and is considered harmless.

What is the difference between suboptimal feed jaundice and breast milk jaundice?

Suboptimal intake jaundice, also called breastfeeding jaundice, occurs most often in the first week of life when breastfeeding is being established. Newborns may not receive optimal milk intake, leading to elevated bilirubin levels due to increased bilirubin reabsorption in the intestines. Inadequate milk intake also delays the passage of meconium, which contains large amounts of bilirubin that is then transferred to the baby’s circulation. In most cases, breastfeeding can and should continue. More feedings can reduce the risk of jaundice.

Breast milk jaundice most often occurs in the second week of life or later and can continue for several weeks. While the exact mechanism that leads to breast milk jaundice is unknown, it is believed that substances in breast milk inhibit the ability of the baby’s liver to process bilirubin.

Phototherapy is a common treatment for jaundice. Other therapeutic options include temporary supplementation with donor human milk or infant formula and, rarely, temporary cessation of lactation.

Should a mother continue to breastfeed if her child is jaundiced?

supplementation may include expressed breast milk from the mother, pasteurized donor human milk, or infant formula.

Generally. Most newborns with jaundice can continue to breastfeed. More frequent breastfeeding can improve the mother’s milk supply and, in turn, improve the caloric intake and hydration of the baby, thereby reducing elevated bilirubin. In rare cases, some babies may benefit from a time-limited break (12-48 hours1,2) from breastfeeding with replacement feeding to aid in the diagnosis of breast milk jaundice. Ongoing clinical evaluation, including repeated bilirubin levels, will help determine when lactation can be resumed. In the Academy of Breastfeeding Medicine clinical protocols on supplementation and jaundice. If a temporary interruption to lactation is required, it is essential to help mothers maintain their milk supply during this time.

Should a breastfed baby with jaundice be supplemented?

Sometimes. Jaundice is one of the possible indications for supplementation in healthy term infants, as described in the Academy of Breastfeeding Medicine clinical protocols on supplementation and jaundice. Any decision about supplementation for a newborn with jaundice should be made on a case-by-case basis.

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