Breast Milk Jaundice

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What is breast milk jaundice? – This refers to jaundice that arises in a newborn baby as a result of breastfeeding. Jaundice refers to yellowish colouration of the skin and white portion of the eyes due to accumulation (in the blood) of a yellow pigment (bilirubin), from the breakdown of red blood cells. While jaundice in newborn generally is a common condition, breast milk jaundice is not that common, affecting about 3% of newborn children.

When does breast milk jaundice manifest?

Breast milk jaundice usually manifests about one week after birth and may last up to three months in some cases, though clears in three to four weeks in majority of cases.

How does milk jaundice develop?

Bilirubin is a waste product of red cell breakdown, which the liver normally metabolises into a form which can easily be excreted from the body. The liver of an average newborn baby is not mature enough to handle the quantity of bilirubin presented to it at delivery; thereby making the rest persists in the blood as yellow pigment referred to as jaundice.

In addition to this, infants with breast milk jaundice have impairment in the enzyme that metabolises bilirubin. This slows down bilirubin metabolism and allows its accumulation in the blood. However, as the liver matures, the activity of the enzyme improves, leading to improved handling of bilirubin metabolism and clearing the excess bilirubin in the circulation. 

Which baby is at risk of breast milk jaundice?

Any baby being breastfed is at risk of breast milk jaundice. Though the cause is unknown, however, it has been noted to run in families, which suggests that it may be genetic. Breast milk jaundice rarely causes severe elevation of bilirubin level. 

What are the symptoms of breast milk jaundice?

Symptoms are that of jaundice generally such as yellowness of the skin and sclera (white portion of the eyes), frequent cries, weakness and poor weight gain. These symptoms may not be so pronounced as in children with jaundice from other causes, as the level of bilirubin may not be as high as in those caused by other conditions. 

How is the diagnosis of breast milk jaundice made?

The affected babies are breastfeeding well and develop jaundice after a week of commencement of breastfeeding. Usually, the yellowness of the skin and sclera may not be too deep. This may easily be missed in dark-skinned children, emphasizing the need for specialist evaluation. However, laboratory measurement of bilirubin level will reveal high blood level of bilirubin than normal. The level will determine the need for treatment or monitoring. 

How is breast milk jaundice treated?

In most babies with breast milk jaundice, treatment is not necessary as bilirubin level is between low and moderate, which can be monitored with serial laboratory tests. This should not discourage breastfeeding as the benefits of breastfeeding outweigh the risks. Also, breast milk is necessary to excrete bilirubin from the gut. When the bilirubin level is very high, treatment may be necessary. This may be by:

  1. Phototherapy – The affected baby is placed under a special light, which shines on the skin to convert bilirubin from its insoluble form to a soluble form that can be eliminated from urine and stool without necessarily waiting for metabolism by the liver. The baby’s eyes are covered with protective glasses or any opaque material in order to avoid undue light exposure which may damage the eyes.
  2. Exchange blood transfusion – In this procedure, the baby’s blood is removed stepwise and replaced with a donated blood which has passed through necessary screening tests to be ascertained fit for the child. This removes the baby’s blood with excess bilirubin and replaces same with normal blood. 

Prognosis of breast milk jaundice

Most babies with breast milk jaundice usually recover without treatment. Jaundice usually clears as the child’s liver matures and is able to metabolise bilirubin better. So, the level of bilirubin in the blood keeps reducing. It may last up to six weeks or more in some cases. However, the child may need evaluation for other causes if jaundice persists and bilirubin level is not reducing as expected. 

Prevention of breast milk jaundice

As the cause of breast milk jaundice is not known for certainty, prevention may be difficult. Breastfeeding should not be stopped because of jaundice (except if advised by a doctor). This is because of the importance of breastfeeding to the wellbeing of infants and the self-limiting nature of jaundice resulting from breastfeeding in most babies.

Adequate breastfeeding of the baby is important in order to remove the bilirubin already in the bowel. Feeding 8 to 12 times a day has been recommended for adequate bowel movement in the baby.   

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