From the Guidelines
Breast milk jaundice is primarily caused by substances in breast milk that inhibit the liver's ability to process bilirubin, and it is not directly related to the frequency of breastfeeding or caloric intake, as suggested by studies focusing on hyperbilirubinemia management 1. The exact mechanism of breast milk jaundice involves certain enzymes in breast milk, such as beta-glucuronidase, which breaks down conjugated bilirubin back into its unconjugated form that cannot be easily excreted. Additionally, some breast milk contains fatty acids that may inhibit bilirubin processing in the liver.
Key Points
- Genetic factors may also play a role, as breast milk jaundice tends to recur in siblings.
- Despite the yellowing of the skin and eyes, breast milk jaundice is generally harmless and does not require stopping breastfeeding unless bilirubin levels become dangerously high.
- Most cases resolve on their own by 12 weeks of age as the baby's liver matures.
- Regular monitoring of bilirubin levels is important, but the benefits of breastfeeding typically outweigh concerns about mild jaundice, and the condition does not cause long-term health problems. It's essential to note that while studies like those published in Pediatrics in 2004 1 provide guidelines for managing hyperbilirubinemia, including the importance of promoting and supporting successful breastfeeding, the direct cause of breast milk jaundice is related to the composition of breast milk rather than breastfeeding practices.
From the Research
Causes of Breast Milk Jaundice
- Breast milk jaundice is an innocuous condition that occurs in some healthy, breastfed infants 2
- The exact causes of breast milk jaundice are still unclear, but it is believed that certain substances in breast milk may be responsible for jaundice 3
- Some studies suggest that breast milk jaundice may be related to the composition of breast milk, including the presence of certain enzymes, growth factors, and other bioactive factors 4
- However, the results of these studies are inconsistent and inconclusive, and the etiology of breast milk jaundice is likely multifactorial 4
Factors Contributing to Breast Milk Jaundice
- Exclusive breastfeeding for the initial six months of life is crucial, but it may also contribute to the development of breast milk jaundice in some infants 2
- The entry of bilirubin into the immature brain may also play a role in the development of breast milk jaundice 2
- Gestational age, blood type, and Rh of neonates may not be significantly affected by breast milk jaundice 5
- Weight loss at the start of phototherapy may be significantly greater in breastfed infants compared to formula-fed infants 6
Treatment and Management of Breast Milk Jaundice
- Interruption of breast-feeding may have the same therapeutic effect as phototherapy in treating breast milk jaundice 3
- Clofibrate may be effective in decreasing bilirubin levels and shortening the duration of phototherapy and hospitalization in infants with probable breast milk jaundice 5
- Phototherapy may be less effective in breastfed infants compared to formula-fed infants, and the addition of formula to the feedings may enhance the efficacy of phototherapy 6