What is Newborn Jaundice?
Jaundice is a common condition in newborns during the first few weeks of life. Before babies are born, they need extra red blood cells. Once they are born and begin breathing air, they no longer need as many red blood cells and the extras must be broken down by the body. A by-product of this process is a substance called bilirubin which causes the yellowish skin color characteristic of jaundice. The bilirubin is processed by the baby’s liver and is eliminated through the stools. This process occurs smoothly in the majority of newborns and at least 50% of breastfed newborns will experience some level of newborn jaundice. Some research has shown that bilirubin, which is an antioxidant, may actually benefit newborns. In many cases all that is required with newborn jaundice is monitoring. With frequent breastfeeding, most babies will pass enough stools to keep their bilirubin levels within safe limits and breastfeeding can continue uninterrupted.
If a baby is not having frequent stools, the bilirubin may be reabsorbed into the bloodstream from the intestines. This can occur if a baby is not breastfeeding effectively, or if there is a delay in the transition of the mother’s milk from colostrum to mature milk. Babies with jaundice are often very sleepy and can be difficult to rouse for feedings. This can complicate the issue since frequent feeding is required for the frequent stools that will lower the bilirubin levels.
There can be circumstances, such as when a mother and baby have incompatible blood types, where jaundice can appear on the first day after the birth, and bilirubin levels may rise more quickly. High bilirubin levels can cause kernicterus which causes brain damage including cerebral palsy and hearing loss. Babies at high risk for this exaggerated jaundice and must be monitored closely. Some treatments that may be suggested in cases such as these include phototherapy and giving supplements of breastmilk or elemental formula to encourage stooling.
Some other risk factors for newborn jaundice are if the mother has diabetes or Rh sensitization, or if the baby experienced bruising during the birth or was born before 38 weeks gestation.
What is a New Parent to Do?
The Academy of Breastfeeding Medicine has a protocol for the management of jaundice in the breastfeeding infant. The main points are:
- Initiate breastfeeding as early as possible, preferably in the first hour after birth. Even with infants born by cesarean delivery, breastfeeding can be started in the first hour.
- Exclusive breastfeeding should be encouraged.
- Breastfeeding infants should not be supplemented with water, glucose water, or formula.
- Supplementation with expressed breastmilk, banked human milk, or elemental formula (in that order of preference) should be limited to infants with with excessive serum bilirubin concentrations.
- Assure ideal position and latch from the outset by having a healthcare provider trained in breastfeeding management (nurse, lactation consultant, lactation educator, midwife, or physician) evaluate position and latch providing recommendations as necessary.
- Respond to the earliest cues of infant hunger, including lip smacking, hand move- ments toward the mouth, restlessness, and vocalizing. Infants should be put to the breast before the onset of crying. Crying is a late sign of hunger and often results in a poor start to the breastfeeding episode.
In my opinion, parents do not need to know the details of newborn jaundice in order to navigate this situation if it occurs. I think of it as a great way for parents to get to practice communicating with their baby’s healthcare providers about their priorities and breastfeeding goals.
If you find yourself in this situation, let your provider know that breastfeeding is important to you and that you want to get it off to the best start possible. Make sure you understand why your provider believes the treatment being proposed is appropriate, and try to remember to politely ask about the benefits, risks and alternatives so you feel well informed about your options. There will be times when the use of phototherapy and/or supplements will be appropriate, and if this is your situation, you can ask about ways to give them that will support breastfeeding. A lactation consultant or nurse familiar with these techniques will be able to help you with at-breast supplementation or other alternatives to bottle feeding if appropriate.
And as always, listen to your baby, listen to yourself and get help when you need it.