Breastfeeding and Jaundice in the First Week of Life

Your newborn baby is gorgeous and her color is great, or so you thought. Soon after birth, the pediatrician will check your baby for jaundice. If you are told that your baby is jaundiced, many questions and concerns may arise..."What is it?" "Why did it happen to my baby?" "How can we get rid of it?" In most cases, the yellowing of a baby's skin is normal and the level of jaundice is fairly low. However, there are times where a baby may get too yellow and need more intervention to lower the bilirubin levels quickly.

Here's how the whole process works.

Why Does the Baby Turn Yellow?

Newborn babies' livers don't conjugate, or consolidate, bilirubin as well as older children's livers. The bilirubin remains in an unconjugated form and builds up in the baby. Jaundice occurs when we see high levels of bilirubin, which causes a yellow color on the baby's skin and in the whites of the eyes. Typically, the baby will eliminate the bilirubin by having bowel movements and further treatment is not necessary, but quite often the bilirubin levels get too high and the baby may require phototherapy with "bili lights" to lower the level. (Phototherapy turns unconjugated bilirubin into lumirubin, a water-soluble molecule which can be excreted in stool and urine, which reduces the baby's jaundice level). It is very important to continue to breastfeed as you usually do and to check in frequently with your pediatrician for the first two weeks of your baby's life.

They will guide you as to when the baby needs to be seen.

What Are the Reasons that the Baby's Bilirubin Would Be Clearing Too Slowly?

The most typical reason is that the baby is not having bowel movements frequently enough. One of the benefits of colostrum is that it aids in cleaning out your baby's intestines.

Even though colostrum is only teaspoons worth, this "first milk" will help your baby to stool. So if you keep putting your jaundiced baby to the breast, he will receive a lot of colostrum and that will result in a lot of bowel movements, which will help the bilirubin to clear rapidly. If you're feeding frequently, yet the baby is still having difficulty stooling, contact your pediatrician. He will want to rule out any other conditions.

What Happens When the Baby Has Lost More than 7 Percent of Her Birth Weight and Is Extremely Yellow?

Chances are, the baby will require phototherapy treatment. The doctor will also tell you that the baby needs more fluids. Breast milk is the preferred supplement, but it may be necessary to give formula. (Depending on the severity, they may recommend IV fluids). If hospitalization is necessary, discuss the fact that you are breastfeeding and that you will need to stay with your baby. Once the doctor determines that the bilirubin levels have dropped, the treatment will be over.

Life returns to normal and you can breastfeed your baby regularly.

What Can You Do to Lower the Baby's Bilirubin Levels on Your Own?

  • As soon as possible after birth, hold your baby skin-to-skin so as to encourage the baby to take the breast. Keep the baby there as often as you can.
  • Breastfeed immediately after birth and very frequently in those first few days. Remember that the more breast milk the baby takes, the more bowel movements he will have.
  • Express your breast milk and supplement your baby, if necessary.
  • If you have a sleepy baby, express your colostrum and feed by cup or spoon.
  • Call a lactation consultant for a breastfeeding checkup to make sure everything is going well.
  • Learn your baby's hunger cues and go with them! Don't wait until your baby is crying to start to feed him.
  • Ensure that you're feeding at least 8 to 12 times in a 24 hour period.
  • If your baby is not waking on her own at the 3-hour mark to feed, it's time to step in and help her along.
  • Strip your baby down to a diaper to keep her awake during feedings and make sure she's sucking properly
  • Continue breastfeeding. It is a myth that water will clear bilirubin.

When Is it Time to Call Your Pediatrician?

  • Your baby is not feeding 8 to 12 times in a 24-hour period.
  • Your baby is not wetting or having bowel movements. By Day 2, you should see at least 2 wet diapers and 3 black tarry stools (meconium); Day 3, at least 3 wet diapers and 3 greenish-brown bowel movements; Day 4, at least 6 wet diapers and 3 mustard yellow bowel movements. Please keep in mind that these guidelines are per day, not the total since birth.
  • Your baby is either too sleepy or too cranky.
  • The color of your baby's skin or eyes are getting even more yellow, bordering on orange. Also, the color is below the belly button level.

Jaundice is very common in newborn babies. The reason for concern and for quick action is that we want to avoid kernicterus. The good news is that there is rarely a problem in full-term healthy babies without infection or blood group incompatibilities, even those with very high levels of jaundice (20-25). As long as the baby is well-hydrated, there is really no reason to worry.

Source:

Journal of Human Lactation. Volume 23, May 2007.

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