Breast milk jaundice is a common condition observed in newborns who are breastfed. It involves a temporary elevation of bilirubin levels in the baby’s blood, leading to a yellowish tint to the skin and eyes. While it can be a source of concern for new parents, this form of jaundice is generally harmless and typically resolves without long-term health problems.
Understanding Jaundice and Bilirubin
Jaundice, a yellowish discoloration of the skin and eyes, occurs when there is an excess of bilirubin in the bloodstream. Bilirubin is a yellow pigment formed during the normal breakdown of old red blood cells. In adults, the liver processes bilirubin, converting it into a water-soluble form for excretion in stool.
Newborns, however, have an immature liver less efficient at processing bilirubin, and produce it at a higher rate due to a greater concentration of red blood cells with a shorter lifespan. This often leads to temporary bilirubin accumulation. The type of bilirubin causing jaundice in newborns is primarily unconjugated (indirect) bilirubin, which is not water-soluble and can deposit in tissues.
Physiological jaundice is the most common and usually benign form of newborn jaundice, appearing after 24 hours and typically resolving within a week or two. It is a normal part of newborn adaptation, reflecting the developing liver’s capacity. While most newborns experience some degree of physiological jaundice, breastfed infants can sometimes develop prolonged jaundice, which may be breast milk jaundice.
Features of Breast Milk Jaundice
Breast milk jaundice typically appears later than physiological jaundice, usually after 3 to 5 days, often peaking during the second week. It can persist for several weeks or even months, with some cases lasting 8 to 12 weeks. Despite the prolonged yellowing, infants with breast milk jaundice are generally healthy, gaining weight well, and producing normal urine and stools.
The exact mechanisms contributing to breast milk jaundice are not fully understood, but certain substances in mother’s milk may influence the infant’s ability to process bilirubin. These substances might increase bilirubin reabsorption from the intestines or inhibit liver enzymes responsible for bilirubin breakdown. This condition is distinct from “breastfeeding jaundice,” which occurs in the first week of life due to insufficient milk intake, leading to dehydration and reduced bilirubin excretion. Breast milk jaundice, conversely, occurs in well-fed, thriving breastfed babies.
Detection and Care
Detection of breast milk jaundice often begins with visual assessment of the infant’s skin and eyes for yellowing. If jaundice is suspected, blood tests measure total serum bilirubin (TSB) levels, specifically focusing on unconjugated bilirubin. While a TSB level above 1.5 mg/dL is considered elevated, most infants do not appear jaundiced until levels exceed 5 mg/dL.
For breast milk jaundice, bilirubin levels can range significantly. Approximately 30-40% of breastfed infants may have bilirubin levels at or above 5 mg/dL, and 2-4% of exclusively breastfed infants might have levels exceeding 10 mg/dL by the third week of life. Maximal concentrations in breast milk jaundice can reach 10-30 mg/dL, typically observed during the second to third week. Medical intervention is considered for very high levels, especially if they approach thresholds that could pose a risk for neurotoxicity.
Management strategies for breast milk jaundice prioritize continued breastfeeding. Frequent feedings can help by increasing milk intake and promoting bilirubin excretion through stool. In rare instances, and under medical guidance, temporary interruption of breastfeeding for 12 to 48 hours, with formula supplementation, might be considered to confirm the diagnosis and observe a rapid drop in bilirubin levels. Phototherapy, which uses light to break down bilirubin, is a common treatment for elevated bilirubin levels, though used selectively for breast milk jaundice. Most cases of breast milk jaundice resolve spontaneously without specific treatment.