From the Guidelines
Elevated bilirubin levels in breastfed babies can last for 3-12 weeks after birth, with most cases of physiologic jaundice resolving within the first two weeks of life. The duration of elevated bilirubin levels in breastfed babies is influenced by the type of jaundice, with breast milk jaundice persisting for several weeks to months 1. Key factors to consider include:
- The benefits of continued breastfeeding outweigh the risks, and temporarily interrupting breastfeeding is rarely necessary 1
- Monitoring is crucial to identify cases of severe jaundice that may require intervention, such as phototherapy 1
- Parents should be aware of signs of severe jaundice, including intense yellow skin color, lethargy, poor feeding, and high-pitched crying, which warrant immediate medical attention. It is essential to promote and support successful breastfeeding, as recommended by the American Academy of Pediatrics 1, to minimize the risks of hyperbilirubinemia and ensure the best possible outcomes for breastfed babies. Breast milk jaundice can begin after the first week and may continue for several weeks to months, with some cases lasting up to 12 weeks 1. The extended duration of elevated bilirubin levels in breastfed babies occurs because certain substances in breast milk can inhibit the liver's ability to process bilirubin efficiently 1. While these elevated levels are usually mild and don't require intervention, monitoring is important to identify cases that may require treatment, such as phototherapy 1.
From the Research
Duration of Elevated Bilirubin in Breastfed Babies
The duration of elevated bilirubin levels in breastfed babies can vary.
- Studies have shown that breastfed infants are more likely to develop prolonged hyperbilirubinemia than those fed formula 2, 3.
- In a study of predominantly breastfed infants, 43% had transcutaneous bilirubin (TcB) levels ≥5 mg/dL at age 21 ± 3 days, and 34% were clinically jaundiced 3.
- At 28 ± 3 days, the TcB was ≥5 mg/dL in 34% of infants, and 21% were jaundiced 3.
- Another study found that the peak bilirubin concentration and duration of jaundice were significantly higher in preterm infants fed breast milk compared to those fed an artificial preterm formula 4.
- The natural history of jaundice in breastfed infants shows that it is normal for 20% to 30% of predominantly breastfed newborns to be jaundiced at age 3 to 4 weeks, and for 30% to 40% of these infants to have bilirubin levels ≥5 mg/dL 3.
Factors Influencing Duration of Elevated Bilirubin
Several factors can influence the duration of elevated bilirubin levels in breastfed babies, including:
- Gestational age: Decreasing gestational age is associated with higher transcutaneous bilirubin levels 5.
- Feeding pattern: Breastfed infants are more likely to develop prolonged hyperbilirubinemia than those fed formula 2, 3.
- Cephalocaudal progression of jaundice: The jaundice zone score does not provide an accurate assessment of the bilirubin level, but a score of zero suggests that the level is unlikely to be >12.9 mg/dL, whereas a score of ≥4 usually predicts a level of ≥10 mg/dL 3.
Monitoring and Follow-up
- Transcutaneous bilirubin measurements can be used to monitor bilirubin levels in breastfed infants 3, 5.
- Infants who require closer evaluation and observation initially are those whose bilirubin levels are >95th percentile, or increasing more rapidly than 0.22 mg/dL per hour in the first 24 hours, 0.15 mg/dL per hour between 24 and 48 hours, and 0.06 mg/dL per hour after 48 hours 5.
- Follow-up examinations are necessary to ensure that the bilirubin levels are decreasing and that the infant is not at risk for bilirubin brain injury 6.