Jaundice in Newborns

Jaundice in Newborns and the Importance of Breastfeeding.

Why do some babies become jaundiced?

While a baby is inside the mother’s womb, he/she needs extra hemoglobin, to carry oxygen to different parts of the body. Once the baby is born, he/she no longer needs the excess hemoglobin, and so it will be broken down and eliminated from the body.

Is breastfeeding important?

The hemoglobin is broken down until it is bilirubin, which moves into the baby’s liver and is made water soluble so that it can now be eliminated by means of bowel movements. Some of the bilirubin in the liver will then head back into the bloodstream to begin the jaundice cycle all over again.

Once the baby’s gut is colonized with bacteria needed for proper digestion, the bilirubin will be prevented from being reabsorbed again.

The term “jaundice," means “yellow in color" and refers to the yellowing of a baby’s skin, owing to the accumulation of orange-colored bilirubin.

Yellow Jaundice is common in healthy new-born babies; about 60% of all babies get physiological jaundice ( normal neonatal jaundice ).

Physiological jaundice in newborns will usually peak at day 5 and 6 and then fade within a week.

Pathological jaundice, which is a more serious type of jaundice, will usually occur straight after birth and is common in preemies or those with illnesses such as Hypothyroidism, blood group incompatibility or G6PD deficiency.

Can Newborn Jaundice be Dangerous?

Some babies may struggle to handle high levels of bilirubin. There is the rare risk of bilirubin entering the brain. Bilirubin is toxic and can cause brain damage, but this is typically only seen in babies who are already ill.

jaundiced eyes, jaundice eyes, baby with jaundice

Infant Jaundice Symptoms

  • A yellowish appearance to the skin and “jaundiced eyes."
  • The baby may be sleepier than usual.
  • One of the symptoms of jaundice in babies is poor appetite.

Jaundice and Breastfeeding

  • Jaundice can make a baby sleepier than usual, which can sometimes lead to a decrease in milk intake. 
  • It is essential that the baby gets in enough milk so that he/she can pass stools, through which the bilirubin is expelled.  Try to breastfeed as often as possible. 
  • Phototherapy for jaundice: Phototherapy in healthy full-term babies that have jaundice on the third day after birth, for bilirubin levels  <300 µmol/L, is not necessary and can be detrimental to the breastfeeding relationship. 
  • Parents should find out about “biliblankets," which have flexible fiber-optic pads and can be wrapped around the baby, instead of using a phototherapy crib; which means that the baby is restricted to a crib and blindfolds. This allows babies to have the therapy done at home, and testing is done in the hospital. This will give the baby more time at the breast. 
  • Parents can also decide to take a minimalist approach to psychological jaundice treatment and choose to use indirect sunlight instead of Phototherapy. 
  • Breastfeeding the baby early and frequently will help decrease bilirubin levels quickly. The colostrum is especially important, as it acts as a natural laxative, helping the baby excrete the bilirubin through the stool. 
  • Breastfeeding will also encourage healthy gut flora, this increases the number of enzymes that process bilirubin. 
  • Babies should not be given any other supplements. Increase in urine excretion does not lower bilirubin levels. If the baby needs supplementation because of dehydration, expressed breast milk should be provided, or donor milk as the next best choice. 

When the Mother is Advised to Stop Breastfeeding

    The American Academy of Paediatrics and the World Health Organization strongly advise against the advice to stop breastfeeding. The AAP stated in 2004 practice guidelines on the management of jaundice in newborns: 

‘ Clinicians should advise mothers to nurse their infants at least 8 to 12 times per day for the first several days, increasing the frequency of nursing, decreases the likelihood of subsequent significant hyperbilirubinemia in breastfed infants.... ‘

They also do not support the routine supplementation of non-dehydrated breastfed babies with dextrose water or plain water, as this will not decrease bilirubin levels, in other words breastfeeding should be encouraged and not stopped. 

The best cure for jaundice in infants is breast milk!

How to Prevent Jaundice in Newborns

  • Breastfeed on demand and as frequent as possible. Avoiding being separated from your baby. Not breastfeeding enough is one of the possible causes of jaundice in the newborn.
  • Make sure that your baby has a good latch and is swallowing milk while feeding. Is my baby getting in enough milk?
  • Avoid oxytocic drugs such as Pitocin and Syntometrine during labor. 
Top of jaundice in newborns page

Treating Newborn Jaundice

Tracy Behr, CBC, CLD (CBI)

Reference: Breastfeeding course through Childbirth International on the physiology of breastfeeding / Health problems / Jaundice.

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