Jaundice, a yellowing of the skin and eyes, is common in newborns, affecting approximately 60% of full-term infants within their first week. This yellow discoloration occurs due to a buildup of bilirubin, a yellowish pigment produced when red blood cells naturally break down. While the liver typically processes bilirubin for excretion, a newborn’s liver may not be mature enough to efficiently remove it, leading to its accumulation. This article explores jaundice specifically in breastfed infants, detailing its forms, causes, diagnosis, and management.
Understanding Breastfed Jaundice
Breastfed jaundice refers to two distinct types: “breastfeeding jaundice” and “breast milk jaundice.” Breastfeeding jaundice, also known as lack-of-breast-milk jaundice or starvation jaundice, typically appears within the first few days of life, often peaking around days two to four. This type is associated with insufficient milk intake, which can lead to dehydration and reduced frequency of bowel movements. This hinders bilirubin excretion, causing it to build up.
In contrast, breast milk jaundice generally emerges later, usually after the fifth day of life, and can persist for several weeks, sometimes up to 3 to 12 weeks. This condition occurs in otherwise healthy, thriving breastfed babies who are receiving adequate milk. Unlike breastfeeding jaundice, it is not linked to poor feeding or insufficient milk supply. Breast milk jaundice is sometimes called prolonged physiological jaundice because it is a longer-lasting form of normal newborn jaundice.
Why Breastfed Jaundice Occurs
The underlying reasons for each type of breastfed jaundice differ. Breastfeeding jaundice stems from inadequate milk intake during the initial days after birth. This can result from difficulties with latching, infrequent feedings, or a delay in the mother’s milk supply “coming in.” When a baby does not receive enough milk, their bowel movements may be less frequent, which delays the excretion of meconium—the baby’s first stool—that contains bilirubin. This delayed excretion allows bilirubin to be reabsorbed into the baby’s bloodstream, causing levels to rise.
Breast milk jaundice, however, is not caused by insufficient milk intake. The exact mechanism remains under investigation, but it is believed to involve substances within the breast milk itself that interfere with the baby’s ability to process bilirubin. Some theories suggest the presence of an enzyme called beta-glucuronidase in breast milk, which can deconjugate bilirubin in the infant’s intestines, leading to increased reabsorption. Other proposed factors include substances in breast milk that may inhibit the liver enzyme glucuronyl transferase, which is responsible for conjugating bilirubin for excretion.
Diagnosis and Management
Diagnosing breastfed jaundice typically involves a visual assessment of the baby’s skin and eyes for yellowing. However, visual inspection alone is insufficient for diagnosis; healthcare providers will measure bilirubin levels. This can be done through a blood test, which provides a total serum bilirubin level, or via a skin test using a transcutaneous bilirubinometer. The bilirubin level, along with the baby’s age and other risk factors, guides treatment decisions.
Management strategies for breastfed jaundice focus on ensuring the baby receives adequate nutrition and facilitating bilirubin excretion. For breastfeeding jaundice, increasing feeding frequency to 8-12 times per day and ensuring a proper latch are primary interventions. This promotes more frequent bowel movements, which help eliminate bilirubin. If bilirubin levels are high or rising rapidly, phototherapy may be recommended. This treatment involves exposing the baby to special blue-green lights, which change bilirubin molecules into a form that can be more easily excreted in urine and stool. Temporary supplementation with expressed breast milk, donor human milk, or infant formula might be considered in specific cases, but continued breastfeeding support is generally emphasized.
When to Seek Medical Attention and Outlook
While most cases of breastfed jaundice are benign and resolve without long-term complications, parents must recognize signs that warrant immediate medical attention. Seek prompt medical care if the baby’s yellowing intensifies or spreads rapidly, especially to the abdomen or legs. Other concerning symptoms include lethargy, poor feeding, a high-pitched cry, dark yellow urine, or pale stools. These signs could indicate very high bilirubin levels that may pose a risk.
Breastfeeding jaundice typically resolves as breastfeeding becomes well-established and milk intake increases, often within the first two weeks. Breast milk jaundice, while potentially lasting longer—up to several weeks or even a few months—is generally harmless in healthy, full-term infants. With appropriate monitoring and management, the outlook for babies with breastfed jaundice is positive, and continued breastfeeding is encouraged.