From the Guidelines
Breast milk jaundice should be managed by continuing breastfeeding, as the benefits of breastfeeding exceed the harms, and it is recommended to continue breastfeeding even in infants who require phototherapy. This approach is supported by the American Academy of Pediatrics (AAP) 1, which suggests that breastfeeding should be continued in breastfed infants who require phototherapy, as it provides numerous benefits to the infant.
Key Considerations
- Breast milk jaundice typically develops after the first week of life and can persist for several weeks to months 1.
- Unlike physiological jaundice, breast milk jaundice is not usually a cause for concern and does not require specific medication.
- The AAP recommends that breastfeeding should be continued in breastfed infants who require phototherapy 1, and supplementation with expressed breast milk or formula may be necessary if the infant's intake seems inadequate or if the infant is dehydrated.
- Temporarily interrupting breastfeeding for 24-48 hours may be suggested in rare cases of very high bilirubin levels, during which time formula feeding would be used, followed by resuming breastfeeding.
Management Strategies
- Continue breastfeeding in most cases, as the benefits of breastfeeding exceed the harms 1.
- Monitor the baby's bilirubin levels regularly through blood tests to ensure they remain within safe ranges.
- Consider phototherapy (light therapy) if bilirubin levels become concerning, although this is uncommon with isolated breast milk jaundice.
- Supplementation with expressed breast milk or formula may be necessary if the infant's intake seems inadequate or if the infant is dehydrated 1.
From the Research
Definition and 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 thought to be related to substances in breast milk that can increase bilirubin levels 3.
- There are two types of jaundice associated with breastfeeding: early onset breastfeeding jaundice and later onset, prolonged jaundice, known as the breast milk jaundice syndrome 4.
Management and Treatment of Breast Milk Jaundice
- Interruption of breast-feeding can be an effective treatment for hyperbilirubinemia in full-term infants, with the same therapeutic effect as phototherapy 3.
- However, breastfeeding interruption is no longer recommended as a diagnostic procedure to identify breast milk jaundice due to its low specificity and the risk of disregarding the detection of a potentially dangerous disease 5.
- In most cases, breastfeeding can and should continue without any interruption, and early breastfeeding support can help prevent early onset jaundice 5, 6.
- Management of jaundice in the breastfed infant involves referral to local services to determine bilirubin levels and exclude pathologies, and temporary interruption of breastfeeding may be indicated if serum bilirubin concentrations are above 270 mumol/l and rising 6, 4.
Benefits and Risks of Breastfeeding During Jaundice
- Exclusive breastfeeding for the initial six months of life is crucial, and breast milk jaundice may reflect a holistic expression of tissue protection and enhanced neonatal survival 2.
- Breastfeeding confers a range of benefits, including fewer infections, enhanced organ and physiological barrier maturity, and the prospect of genetic modification of certain diseases 2.
- However, the potential dangers of jaundice in the neonate, such as bilirubin induced neuronal pathology, mandate a better understanding of the pathophysiology of breast milk jaundice and the impact of breastfeeding during jaundice 2.