From the Guidelines
A mother can continue breastfeeding her 3-day-old infant with hyperbilirubinemia, as breastfeeding helps resolve jaundice by promoting intestinal motility and bilirubin excretion through stool. The infant will likely need phototherapy treatment for the hyperbilirubinemia while continuing to breastfeed, as recommended by the American Academy of Pediatrics (AAP) 1. The mother should increase breastfeeding frequency to 8-12 times per 24 hours to help clear the bilirubin through increased stooling.
Key Considerations
- During phototherapy, the baby may need to be temporarily removed from the lights for feeding sessions, but breastfeeding should not be discontinued 1.
- Supplementation with expressed breast milk or formula may be recommended if the baby is not feeding well or is dehydrated, as stated in the AAP guidelines 1.
- Breastfeeding has been shown to reduce bilirubin concentrations, with a study documenting that breastfeeding 9 to 10 times a day is associated with lower bilirubin concentrations 1.
- The elevated bilirubin level requires medical evaluation, as levels above 15 mg/dL in a 3-day-old infant typically warrant treatment to prevent complications.
- The mother should watch for signs of adequate intake, including:
- 6-8 wet diapers daily
- Yellow seedy stools
- The infant appearing satisfied after feeds
- Regular follow-up with the healthcare provider is essential to monitor bilirubin levels until they decrease to a safe range.
Breastfeeding Benefits
- Promotes intestinal motility and bilirubin excretion through stool
- Provides short- and long-term health benefits, including reduction of necrotizing enterocolitis, late-onset sepsis, chronic lung disease, retinopathy of prematurity, and improved outcomes 1
- Increases stooling in the newborn, which increases bilirubin excretion in the stools 1
From the Research
Breastfeeding with Hyperbilirubinemia
- A 3-day-old infant with hyperbilirubinemia can continue breastfeeding, but it is essential to monitor the infant's condition and adjust the breastfeeding schedule as needed 2, 3.
- Hyperbilirubinemia may have a negative effect on breastfeeding and milk intake, with bilirubin levels above 12 mg/dL adversely affecting breastfeeding 2.
- The response to phototherapy in breast-fed infants is slower than in formula-fed infants, and the addition of formula to the feedings may enhance the efficacy of phototherapy and reduce exposure time 3.
Phototherapy and Breastfeeding
- Phototherapy is effective in reducing bilirubin levels in infants with hyperbilirubinemia, but the duration of exposure may be longer in breast-fed infants than in formula-fed infants 3.
- The overall rate of decrease in bilirubin concentration during phototherapy is slower in breast-fed infants than in formula-fed infants 3.
- Breastfeeding can continue during phototherapy, but the infant's bilirubin levels and overall condition should be closely monitored 3, 4.
Predicting Hyperbilirubinemia
- A serum bilirubin level of ≥6 mg/dL on the first day of life can predict the development of significant hyperbilirubinemia in healthy term newborns 5.
- The 95th percentile for serum bilirubin levels in breast-fed infants is 14.5 mg/dL, compared to 11.4 mg/dL in formula-fed infants 6.
- Breast-feeding is associated with an increased risk of hyperbilirubinemia, even in the first three days of life 6.