1. What Is Jaundice?

Simply put, your fetus needs many more red blood cells than your newborn baby. These cells carry the necessary oxygen through your placenta and once your baby is breathing air these no-longer-needed red blood cells begin to break down and a by-product of this breakdown is called bilirubin. Newborns can make the fetal-adult blood transition easily but have an immature liver that does not yet have the ability to cope with the bilirubin. The result is a yellowing of your baby’s skin and the whites of her eyes.  This yellowing, called jaundice.

Jaundice is an extremely common finding in newborn infants after the first 24 hours; between 60% of full term and 80% of preterm infants. The yellowing peaks on the 3rd day of life and diminishes over the first week. In breastfed infants, persistent jaundice can be found in 10% of infants at 1 month or longer.

Note: Early onset jaundice occurring within 24–48 hours of birth is unlikely to be related to breastfeeding and should be assessed and treated promptly without interruption of breastfeeding.

2. The Best Thing You Can Do:

Get more breastmilk into your baby. Your colostrum is designed to  be a natural laxative and your newborn’s perfect food.

When your baby doesn’t swallow enough colostrum it leads to a delay in the passage of meconium, your baby’s first stool. There are over 400 mgs. of bilirubin in this poop. Your breastmilk is the best food for your baby to help ease it all out and not be reabsorbed by her intestines.

In the first 24 hours of life, it is expected that your exclusively breastfed baby may actually swallow no more than a teaspoon of your milk per feeding.  Encouraging breastfeeding during the first hour after giving birth-and at least 8 times more-increases your baby’s calorie intake and very importantly stimulates your breast milk production...so important in the first 72 hours.

There is a risk of complications when the bilirubin circulates in high levels for prolonged periods, enabling it to cross the blood-brain barrier. This is why getting breastmilk into your baby is so important and why your baby’s bilirubin levels must be monitored.

If warranted, your baby’s health care provider will treat her with blue and white light phototherapy lamps. Phototherapy can be done in the hospital or at home. Home phototherapy using a bili blanket is acceptable for low-risk infants provided blood levels are monitored. In the hospital, try to have the lighted isolette set up in your room to ease the breastfeeding and reduce your separation time.  Research has shown that interruption of phototherapy for durations of up to 30 minutes or longer to permit breastfeeding without eye patches, does not alter the effectiveness of the treatment.

A follow-up visit with your pediatric health care provider within 2 days of discharge is advised to keep a close check on your baby’s bilirubin level as well as establishing a baseline weight for future breastfeeding assessments. In most cases breastfeeding can, and should, continue.

New research published in Science Reports 2018 suggests that there may be a good reason for the presence of this bilirubin; protecting newborns from Group B Streptococcus. Bilirubin may have antibacterial properties against GBS protecting infants against sepsis, a system-wide infection. More research is underway concerning E. Coli infections.

Breast feeding is the most important thing you can do, right from the start, to flow through the jaundice issue with as little worry and intervention as possible. Understanding the balance is the job of knowledgeable health care providers. Each mother-baby dyad is unique and requires an individualized care plan to meet its medical and breastfeeding needs.