From the Guidelines
Breast milk jaundice is a common and generally harmless condition in newborns that can be managed with continued breastfeeding and, if necessary, temporary phototherapy, without interrupting breastfeeding, as recommended by the American Academy of Pediatrics (AAP) 1.
Management of Breast Milk Jaundice
The management of breast milk jaundice prioritizes the continuation of breastfeeding, as it provides numerous benefits to the infant, including the promotion of healthy gut bacteria and the enhancement of the infant's immune system.
- Regular feeding schedules should be maintained, with 8-12 feedings per day, to ensure adequate milk intake and help eliminate bilirubin through bowel movements.
- If bilirubin levels become significantly elevated, typically above 20 mg/dL, phototherapy may be recommended temporarily to reduce bilirubin levels.
- During phototherapy, expressed breast milk can be given to maintain the breastfeeding relationship, as supplementation with expressed breast milk or formula is appropriate if the infant's intake seems inadequate, weight loss is excessive, or the infant seems dehydrated 1.
Key Considerations
- Breast milk jaundice differs from physiological jaundice, which occurs in the first few days of life, and from pathological jaundice caused by underlying medical conditions.
- Parents should watch for signs of severe jaundice, including extreme yellowing extending to the abdomen, lethargy, poor feeding, or high-pitched crying, which warrant immediate medical attention.
- The condition typically resolves on its own by 12 weeks of age as the baby's liver matures.
Clinical Guidelines
The AAP recommends promoting and supporting successful breastfeeding, performing a systematic assessment before discharge for the risk of severe hyperbilirubinemia, providing early and focused follow-up based on the risk assessment, and treating newborns with phototherapy or exchange transfusion when indicated to prevent the development of severe hyperbilirubinemia and, possibly, bilirubin encephalopathy (kernicterus) 1.
From the Research
Definition and Causes of Breast Milk Jaundice
- Breast milk jaundice is a condition that occurs in some healthy, breastfed infants, characterized by elevated bilirubin levels and visible jaundice [(2,3,4,5,6)].
- The exact causes of breast milk jaundice are still unclear, but it is thought to be related to substances in breast milk that can increase bilirubin levels [(2,3,6)].
- Insufficient intake of breast milk and poor breastfeeding management may also contribute to early onset jaundice [(3,4,6)].
Diagnosis and Management
- Breast milk jaundice is typically diagnosed by excluding other causes of jaundice and monitoring bilirubin levels [(4,6)].
- Management of breast milk jaundice involves continued breastfeeding, as the benefits of breastfeeding outweigh the potential disadvantages of jaundice [(3,5,6)].
- Temporary interruption of breastfeeding may be indicated if serum bilirubin concentrations are high and rising [(2,6)].
- Phototherapy may also be used as a treatment for hyperbilirubinemia, but it has been shown to have the same therapeutic effect as interruption of breast-feeding 2.
Prevention and Support
- Early breastfeeding support and promotion of good positioning, attachment, and baby-led feeding may help prevent early onset jaundice 4.
- Community practitioners should understand the physiology of jaundice and the issues associated with breastfeeding to provide adequate support to parents 4.
- Exclusive breastfeeding for the initial six months of life is recommended, and continued breastfeeding during jaundice can provide numerous benefits to the infant, including reduced risk of infections and enhanced organ maturity 5.