Treatment of Breastfeeding and Breast Milk Jaundice in Infants

Neonatal jaundice is the yellow discoloration of the skin, sclera (“whites” of the eyes), mouth and deeper lying tissues of the body in a newborn baby due to a high level of bilirubin in blood (hyperbilirubinemia). Jaundice can lead to a complication known as kernicterus which is the damage to the brain as a result of bilirubin deposition.

Bilirubin Levels in Babies

In newborns, it is mainly the unconjugated bilirubin that is elevated. Your pediatrician may monitor the total serum bilirubin which is the combination of the unconjugated (“indirect”) and conjugated (“direct”) bilirubin levels in the blood.

Normal bilirubin levels are approximately 1mg/dL (17 umol/L). The signs of jaundice may become clinically evident at a level of  3mg/dL (50 umol/L). In babies, this may be seen as the yellowish discoloration of the sclera (“whites” of the eyes).

The yellow discoloration of the skin may be visible on different areas at the following levels :

• Face = approximately 5mg/dL (85 umol/L)
• Head to mid-abdomen = approximately 15mg/dL (260 umol/L)
• Soles of the feet = approximately 20mg/dL (350 umol/L)

The estimates above should not be used as a means of monitoring jaundice. Treatment for jaundice is only necessary if the bilirubin levels exceeds 20mg/dL. However, it may be commenced sooner if the levels reach 15mg/dL or more in a 2 to 3 day old newborn. Kernicterus may only occur if the bilirubin levels exceed 25mg/dL (430 umol/L).

Treatment of Jaundice in Newborn Babies

There are three causes of jaundice in the newborn which are not pathological, meaning that it is not due to any disease process. This is divided into :

• Physiologic Jaundice
• Non-Physiologic Jaundice
  • Breastfeeding Jaundice
  • Breast Milk Jaundice

These types of jaundice are explained in the article on Neonatal Jaundice.

The treatment for physiologic and non-physiologic jaundice is the same.

• Increase feeding to 8 to 12 times in a day. If the baby does not cooperate with such regular feedings, breast milk should be pumped out between feeds so that a larger volume of breast milk can be offered at feeding time.
  • In breastfeeding jaundice, supplementation with a formula may also be advisable. Water or dextrose solution should not be used for supplementation.
  • Your pediatrician may consider stopping breastfeeding for 2 to 3 days to establish whether it is a case of breast milk jaundice. This should only be considered if the bilirubin levels are rising and reach 20mg/dL and should be followed by a serum bilirubin test after the waiting period.
• Phototherapy with the use of ultraviolet (UV) light should only be considered if the serum bilirubin levels reach 15mg/dL (in 2 to 3 day old newborns) or 20mg (4 days and older newborns). This can be conducted at home with fiberoptic blankets.
  • Serum bilirubin levels should be taken every 12 hours until the bilirubin levels drop below 15mg/dL.
  • Exposure to sunlight as a means of phototherapy should be avoided as there is a possibility of sunburn.