Jaundice | Breastfeeding | CDC

Jaundice, a sign of elevated bilirubin levels, is common during the first weeks of life, especially among preterm newborns. Bilirubin, a product from the normal breakdown of red blood cells, is elevated in newborns for several reasons:

• Newborns have a higher rate of bilirubin production due to the shorter lifespan of red blood cells and higher red blood cell concentration compared to adults.
• Newborns have immature liver function, leading to slower metabolism of bilirubin.
• Newborns may have a delay in passage of meconium, leading to increased reabsorption of bilirubin in the intestines.
• In most newborns, jaundice is termed “physiologic jaundice” and is considered harmless.

What is the difference between suboptimal intake jaundice and breast milk jaundice?

Suboptimal intake jaundice, also called breastfeeding jaundice, most often occurs in the first week of life when breastfeeding is being established. Newborns may not receive optimal milk intake, which leads to elevated bilirubin levels due to increased reabsorption of bilirubin in the intestines. Inadequate milk intake also delays the passage of meconium, which contains large amounts of bilirubin that is then transferred into the infant’s circulation. In most cases breastfeeding can, and should, continue. More feedings can reduce the risk of jaundice.

Breast milk jaundice most often occurs in the second or later weeks of life and can continue for several weeks. While the exact mechanism leading to breast milk jaundice is unknown, it is believed that substances in the mother’s milk inhibit the ability of the infant’s liver to process bilirubin.

Phototherapy is a common treatment for jaundice. Other therapeutic options include temporary supplementation with donor human milk or infant formula, and rarely, temporary interruption of breastfeeding.

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Should a mother continue breastfeeding if her child has jaundice?

Supplementation can include mother’s expressed breast milk, pasteurized donor human milk, or infant formula.

Usually. Most newborns with jaundice can continue breastfeeding. More frequent breastfeeding can improve the mother’s milk supply and, in turn, improve caloric intake and hydration of the infant, thus reducing the elevated bilirubin. In rare cases, some infants may benefit from a time-limited, temporary interruption (12-48 hours^1,2) of breastfeeding with replacement feeding to help aid in the diagnosis of breast milk jaundice. Ongoing clinical assessment, including repeat bilirubin levels, will help determine when breastfeeding can resume. Further guidance is outlined in the Academy of Breastfeeding Medicine’s clinical protocols on supplementation and jaundice. If temporary breastfeeding interruption is required, it is critical to help mothers maintain their milk production during this time.

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Should a jaundiced breastfed infant be supplemented?

Sometimes. Jaundice is one of the possible indications for supplementation in healthy, term infants as outlined in the Academy of Breastfeeding Medicine’s clinical protocols on supplementation and jaundice.   Any decisions about supplementation of a jaundiced newborn should be made on a case-by-case basis.

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Causes, Symptoms, Treatment, and Prevention

Newborn jaundice is when a baby’s skin and eyes turn yellow from too much bilirubin. It usually resolves as their liver matures and they start feeding, but if it persists, there may be another cause.

In most cases, jaundice (also called hyperbilirubinemia) in newborns will disappear within 2 to 3 weeks.

The higher the bilirubin levels are, the more the baby is at risk for brain damage.

Bilirubin is a yellow pigment produced during the typical breakdown of red blood cells. In older babies and adults, the liver processes bilirubin, passing it through the intestinal tract. However, a newborn’s still-developing liver may not be mature enough to do this.

There are two types of newborn jaundice: physiological and pathological.

Physiological jaundice is the most common, accounting for 75% of cases. This just means the baby’s metabolism cannot clear out bilirubin as quickly as it is produced. This type typically develops in a few days and clears up on its own in a few weeks when the breakdown of red blood cells slows and liver function improves.

On the other hand, pathological jaundice means that there is another underlying condition that’s causing a problem with filtering out bilirubin. This type may show up in the first 24 hours after birth.

Possible causes include:

• blood type incompatibilities such as rhesus factor (Rh) or ABO
• breakdown of red blood cells (hemolysis)
• conditions that affect how the body processes bilirubin like Gilbert’s syndrome and Crigler-Najjar syndrome
• diabetes in the birthing parent
• congenital hypothyroidism
• intestinal obstruction
• pyloric stenosis
• breastmilk jaundice, which is a reaction to substances in the milk
• breastfeeding jaundice, which can happen if the baby isn’t feeding well

Pathological jaundice can also be caused by certain medications, such as certain antibiotics.

The first sign of jaundice is the yellowing of a baby’s skin and eyes, which may start in the face before spreading across the body. With physiological jaundice, the yellowing may begin and peak within 2 to 5 days after birth. With other causes, it may begin closer to birth.

However, this yellowing can be harder to see in darker skin tones. Another way to tell is by pressing your finger lightly on the baby’s skin. The spot should briefly appear paler. If it looks more yellow, it’s likely a sign of jaundice.

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If you have concerns or are unsure, contact your baby’s doctor, particularly if the whites of their eyes look yellow.

If untreated, severe newborn jaundiced can lead to acute bilirubin encephalopathy, which is caused by the toxic levels of bilirubin in the brain.

A baby may get a fever, act listless and lethargic, have a shrill cry, refuse to feed, and curve their neck and body backward. This can, in turn, progress to kernicterus, which is permanent brain damage.

In the United States, many hospitals discharge birthing parents and newborns after 24-48 hours before jaundice may become very apparent. If the baby has not developed jaundice within 72 hours of delivery, they’re less likely to have the pathological form. But they can still develop the physiological form, leading to complications.

Once you’re home, contact your doctor if you notice the following symptoms:

• Jaundice spreads or becomes more intense.
• Your baby develops a fever over 100°F (38°C).
• Your baby’s yellow coloring deepens.
• Your baby feeds poorly, appears listless or lethargic, and makes high-pitched cries.

There are some things that can increase the chance of a newborn developing physiological jaundice.

These include:

• premature birth
• history of newborn jaundice in siblings
• being male assigned at birth (MAAB)
• being of Asian descent

In addition, certain risk factors can increase your baby’s chance of developing severe jaundice, which may be physiological or pathological. These include:

• jaundice within 24 hours after birth
• birth before 40 weeks, with the chance increasing the earlier the baby is born
• treatment with phototherapy or a history of a sibling being treated with phototherapy for jaundice
• family history of inherited red blood cell disorders such as G6PD deficiency
• difficulty breastfeeding or chestfeeding
• bruising on the head or scalp from the birth
• having Down syndrome
• Being born bigger than average for gestational age (macrosomia)

Though distinct yellow coloring confirms that a baby has jaundice, additional tests may be needed to determine the severity.

Babies who develop jaundice will get a bilirubin blood test to determine the levels of bilirubin in their blood.

Additional tests may be needed to see if a baby’s jaundice is due to an underlying condition. This may include testing your baby for their complete blood count (CBC), blood type, and Rh incompatibility.

Additionally, a Coombs test may be done to check for antibodies that show an elevated risk of increased red cell breakdown (hemolysis).

Mild jaundice will usually resolve on its own as a baby’s liver matures. Frequent feedings (at least 8 times a day) will help babies pass bilirubin through their bodies.

More severe jaundice may require other treatments. Phototherapy (light therapy) is a common and highly effective method of treatment that uses light to break down bilirubin in your baby’s body.

In phototherapy, your baby will be placed on a special bed under a blue spectrum light while wearing only a diaper and special protective goggles. A fiber-optic blanket may also be placed underneath your baby.

In very severe cases, an exchange transfusion may be necessary. In this procedure, a baby receives small amounts of blood from a donor or a blood bank.

This replaces the baby’s damaged blood with healthy red blood cells. This also increases the baby’s red blood cell count and reduces bilirubin levels.

In addition, if there’s an underlying cause, the baby will need to be treated for the condition to resolve symptoms.

Physiological jaundice can’t be prevented. But you can reduce the chance of development by frequently feeding your newborn, which can help their bilirubin pass through the body more quickly.

If you or your doctor thinks there is a likely underlying issue that could cause jaundice in your newborn, there are tests that can verify this so that you or the baby can get preventive treatment if appropriate.

For example, during pregnancy, you can have your blood type tested to rule out the possibility of Rh incompatibility. If you’re Rh-negative, you can get intravenous immunoglobulin during pregnancy.

What does jaundice poop look like?

Newborns that develop jaundice can have a pale-colored stool, but not often. Most newborns with jaundice will have the same color stool as newborns without jaundice. It may begin as black, dark brown, or dark green in the first few days, and then transition to yellow or orange-colored stool. For this reason, it can be hard to recognize jaundice from the stool color alone.

What color is jaundice pee in newborns?

A newborn with jaundice may have dark yellow urine. As you feed the baby, it should become colorless. Make sure your baby is having at least six diapers daily.

What do babies’ eyes look like with jaundice?

In addition to the yellowing of the skin, jaundice also causes the yellowing of the white part of the eyes.

Most cases of physiological newborn jaundice will clear away, often without treatment. Frequent feedings will help it resolve. But your doctor will still monitor your baby to make sure it is improving.

The outlook of pathological jaundice depends on the underlying cause and what treatment the baby requires. In both cases, without immediate treatment, complications can begin to develop.

The most recent guidelines by the American Academy of Pediatrics (AAP) recommend that all newborn babies be examined for jaundice at least every 12 hours after birth and until their discharge from the hospital

Lamp for phototherapy, treatment of neonatal jaundice.

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Newborn jaundice – a physiological phenomenon caused by an increased content of bilirubin in the blood, manifests itself in the first days and usually disappears by 7-8, sometimes up to 21 days.

The most effective method of treating neonatal jaundice – a consequence of an increased content of bilirubin in the blood – is light or phototherapy, using a special lamp (blue lamp) Philips TL 20W / 52 and Osram L Blue 18W / 71.

Under the influence of the lamp for the treatment of jaundice, toxic bilirubin is converted into non-toxic compounds and excreted from the body of the newborn.

Neonatal jaundice treatment lamp – a special device adapted for safe installation on a baby’s bed, equipped with special lamps that have a limited resource in terms of “usefulness” of treatment.

The working life of such a lamp is 10,000 hours, but the lamp effectively treats jaundice of a newborn only for the first 2000 hours.

Rental Baby Service rents lamps for jaundice treatment, equipped with special sealed meters: long memory counter to determine the total lamp operating time and short memory counter for parents’ convenience – how much exactly your baby takes a “sunbath” of phototherapy.

Children’s medical institutions should be equipped with lamps for the treatment of jaundice, but sometimes jaundice appears in a newborn on the 3rd day, after discharge from the hospital, in addition, to achieve a therapeutic effect, the newborn with his mother will have to stay in the hospital for several days. Of course, it is much more convenient to rent a phototherapy lamp and use it at home.

Before using the lamp for the treatment of jaundice, rented from Baby Service Kharkiv, it is necessary to undergo a short phototherapy safety briefing:

• The entire phototherapy procedure must be supervised by parents.
• The air temperature in the room should be comfortable for an undressed child, drafts are excluded.
• The eyes of a newborn should be covered from light with a special mask or cap pulled over the eyes.
• Compulsory clothing – diapers, the body of the child must be open for the best effect of light therapy.
• How long to lie under the lamp from jaundice? The maximum time for one phototherapy session is not limited, subject to constant supervision by adults. Practice has shown that, on average, at home, parents manage to keep a newborn under a lamp for 5-7 hours a day.

What else can I rent for a newborn? Scales for babies will show you how much the baby gains in one feeding, and renting one of the rocking centers or deck chairs will free up mom’s hands and time to relax.

Neonatal jaundice: to treat or not to treat

Jaundice in adults and older children is always associated with a dangerous disease. And indeed it is. And what is the reason for the appearance of jaundice in a newborn? We asked neonatologist Elena Zimina, head of the department of inpatient replacement technologies of the National Research Center for Children’s Health of the Ministry of Health of Russia, about what this condition is, in what cases it can become dangerous for a newborn, and what parents should pay attention to.

What is neonatal jaundice (NJ) and why does it occur?

It is characterized by yellowness of the skin and sclera due to excessive accumulation of bilirubin in the body. In children under the age of 1 month, the digestive system improves. Specific processes take place in the bone marrow and hematopoietic system: fetal hemoglobin is destroyed and the so-called adult hemoglobin is formed. One of the breakdown products is the bile product bilirubin. It accumulates in the blood and turns the skin yellow. In most cases, HF proceeds physiologically and occurs due to the immaturity of the enzymatic systems of the newborn.

What are the types of VN

Physiological jaundice occurs in most babies and appears after 36 hours of life. This condition is not a disease and passes with time. It decreases by day 14 in a full-term newborn and by day 21 in a premature baby.

Jaundice that appears within the first 24 hours after birth is always a sign of pathology.

Pathological Jaundice is usually a sign of some other disease. It requires treatment prescribed by a doctor. With a very strong increase in the level of bilirubin, it penetrates into the nervous system. This can have a toxic effect, primarily on the vital nerve centers, the brain.

This condition is called “nuclear jaundice” or “bilirubin encephalopathy”. A high level of bilirubin can cause damage to the central nervous system (CNS): lethargy, drowsiness, lethargy, inhibition of the sucking reflex – at an early stage. In the intermediate stage – an increase in muscle tone, increased irritability, often an increase in body temperature. In the advanced stage – CNS damage: convulsions, respiratory failure, coma. Nuclear jaundice irreversibly affects the central nervous system, hearing loss, gaze paralysis, mental retardation, cerebral palsy occur.

Experts note:

1. early jaundice – manifests itself in the first 36 hours of life;
2. prolonged jaundice – persists for more than 14 days in full-term newborns and more than 21 days in premature newborns;
3. late jaundice – appears after 7 days of life.

What factors assess the severity of jaundice

When examining a newborn, doctors evaluate: the color of the skin, sclera, mucous membranes, the stages of manifestation of icteric staining (according to the Cramer scale), the time of manifestation of jaundice, the general condition of the newborn (degree of activity, severity of reflexes, urination frequency and nature of urine, liver and spleen sizes, breastfeeding adequacy, laboratory parameters).

Newborn risk factors

1. Newborn born before 38 weeks of gestation.

2. The presence of hyperbilirubinemia in the previous child in the family.

3. Manifestation of jaundice in the first 24 hours of life.

How does the Rh factor affect the appearance and manifestations of WN

Incompatibility of the Rh factor of the mother and the unborn baby can provoke an Rh conflict, which after birth manifests itself as hemolytic disease of the newborn.

Rh-negative female organism detects the Rh-positive protein of the young organism as foreign. In this case, immune cells are secreted – antibodies.

Antibodies destroy the infant’s red blood cells, releasing high levels of bilirubin, which severely affects the central nervous system of the young organism. Jaundice associated with Rhesus conflict in the blood type of mother and child is usually determined in the first days of a child’s life.

Prevention

In order for the baby to grow up strong and healthy, the expectant mother needs to maintain a healthy lifestyle during pregnancy. If a woman has a negative Rh factor, she needs to inform the doctor as fully as possible about possible previous pregnancies, abortions, blood transfusions and operations. In addition, it is important to determine the level of Rh antibodies in a pregnant woman and conduct an immunological examination of the future father. After the birth of a child, it is imperative to maintain adequate natural feeding.

Treatment

A doctor can determine whether or not jaundice is dangerous for a baby by looking at the level of bilirubin in the baby’s blood.