Jaundice Care Plan

 

Breastfeeding during Jaundice

 

If my baby is jaundiced, can I still breastfeed? 

Yes!  Typically, MORE breast milk is needed to flush the jaundice from your baby’s system.  You can pump for a few minutes after the baby nurses and offer extra breast milk to your baby during this time if needed.

 

Is it normal for babies to be very sleepy when they are jaundiced? 

Yes.  We don’t know exactly why, but some jaundiced babies are so sleepy that they will sleep too long between feedings and fall asleep easily during feedings (Wilson-Clay, 2013).  Make sure your baby has at least 8 feedings every 24 hours.  If your baby is too sleepy to nurse enough to gain weight, see Operation Night in Day and Plan P.

 

What is the best way to protect breastfeeding during this time? 

Jaundice only lasts a few days for most newborns.  There are more specifics below, but in general until jaundice resolves, your priorities are:

 

  1. Feed the baby.  Breast and bottle if necessary.
  2. Protect the milk supply.  Pump after nursing or instead of nursing if necessary.
  3. Protect the breastfeeding relationship.  Nurse a few minutes if both of you are “stable and able”, then bottle feed your baby the first of his bottle next to your breast before you pump.  Return to exclusive breastfeeding as soon as you're  both “stable and able”.  (See Transitioning Back to the Breast)

 

If our pediatrician advises us to feed infant formula the baby, should I pump my breasts too?  Yes.  If your baby needs formula, your breasts need a pump.  If your baby is not gaining weight well and/or needs extra milk to help him get rid of jaundice, your body could use some help establishing and maintaining your milk supply during these few days.  Pump briefly after each nursing while someone else is offering the baby his extra milk.  The sooner you start pumping and offering your milk as the extra milk, the less formula your baby will need.  The type of breast pump you use during this time matters, especially if the baby is not nursing well for any reason.  (See Pumps and Pumping)

 

Does it matter what kind of formula we use? 

Yes.  Evidence suggests that a special type of formula helps eliminate jaundice more quickly and is also less likely to induce milk allergy or sensitivity (ABM #22).  Ask your pediatrician about using a extensively hydrolyzed protein formula, such as Nutramigen (Gourley, 2005, 2001, 1999, 1992)

 

How do babies get jaundiced? 

Nearly half of all full term healthy newborns will develop visible jaundice.  It is usually harmless and goes away within a few days.  All babies are born with extra red blood cells and when the baby’s liver begins to break them down a yellow pigment called bilirubin is produced.  Bilirubin seeps from the baby’s blood into his skin.  The amount of bilirubin in his blood can be determined with a blood sample from your baby’s heel.  Jaundice leaves your baby’s body in his poop, so effective breastfeeding will help him get rid of jaundice.  Ineffective breastfeeding, caused by poor latch or sleepy, infrequent feedings can result in a higher bilirubin level in your baby’s blood.  Some babies, such as premature babies (babies born more than 2 weeks early), babies with excessive bruising, or babies of diabetic mothers can be at higher risk for jaundice.

 

How do we get rid of jaundice? 

Feed the baby.  Your baby’s individual treatment plan will depend upon several factors, but the number of days old your baby is in relation to how high his bilirubin blood level is will determine the general course of action.  The most important aspect of the plan is to feed the baby.  Bilirubin has to be pooped out of the gut, so without lots of milk, there’s not lots of poop.  Protecting the baby’s rest so that he can breastfeed effectively is vital (see Operation Night in Day).  If you cannot get your baby awake enough to eat well, offering extra breast milk or formula in a bottle becomes necessary.  Don’t worry about this temporary situation, just protect your milk supply until the baby becomes more alert and is “ready for primetime” again (see Pumps and Pumping, Plan P and Transitioning Back to the Breast).  Remember, if your baby was a good nurser prior to jaundice, that’s “who he really is”; he will be a good nurser again.  If extra feeding doesn’t keep the bilirubin level in the normal range, your baby may need phototherapy.  See below.

 

What do the bilirubin numbers mean? 

Typically, bilirubin levels are elevated between days 3 and 5 of life, peaking on day 4 or 5.  If the bilirubin levels stay below 15 mg/dL, and your baby doesn’t have any other medical conditions, the jaundice is considered harmless.  Just keep feeding him and he’ll keep pooping it out.  If bilirubin levels are between ~17 mg/dL and ~20 mg/dL or you baby has other risk factors (like prematurity), the jaundice may need to be treated with phototherapy.

 

What is phototherapy? 

This is a special blue light therapy.  When these special lights are shined on the baby’s skin, it helps the body break down the red blood cells faster, which helps the bilirubin get moved into the gut to be pooped out faster.  Phototherapy is ordered by your baby’s doctor and in our practice a home health agency brings a special blanket with lights built in that our patients use at home.  If the bilirubin level is above 20 mg/dL, your pediatrician may want to have your baby treated with a larger set of lights that the baby lies under at the hospital.  The bilirubin blood level is checked repeatedly while your baby is undergoing phototherapy until they have reached and maintained a normal level for your baby’s age and risk factors.

 

Is it recommended to place the baby in indirect sunlight, offer water in a bottle, or replace breast milk with formula? 

No.  The American Academy of Pediatrics now discourages these practices.  You may read more about this and discuss it with your pediatrician.  http://aappolicy.aappublications.org/cgi/reprint/pediatrics:114/1/297.pdf

 

If our pediatrician advises me to stop breastfeeding completely for a time and offer formula instead, how do I protect myself from painful breast engorgement and loss of milk supply? 

Interrupting breast milk feedings for even 24 hours requires effective breast drainage at least 8 times every hours with a high quality breast pump.  See Pumps and Pumping.  If you do not drain your breasts 8+ times every 24 hours, you are at increased risk for severe engorgement, plugged milk ducts, breast infection, and a decrease in milk supply.  In addition, if your baby needs some time to transition back to breastfeeding (see Transitioning Back to the Breast), you will need to continue pumping while you work with your baby.  If you develop symptoms of infection (fever, chills, aches, breast pain, etc), see your OB or another healthcare provider ASAP.

 

Jaundice is temporary.  The changes to your feeding plan will be short term.  Stay in touch daily with your IBCLC until jaundice is resolved and breastfeeding is going smoothly.

 

 

Copyright 2017  Gloria Dudney, RN, BSN, IBCLC, RLC

 

 

References

  1.  Academy of Breastfeeding Medicine Protocol #22, available at bfmed.org
  2. Gourley, GR, et al.  A controlled, randomized, double-blind trial of prophylaxis against jaundice among breastfed newborns. Pediatrics 2005 Aug: 116 (2):385-91.
  3. Kreamer, et al.  A Novel Inhibitor of B-Glucuronidase: 1-Aspartic Acid. Pediatric Research 2001 Nov: 460-464.
  4. Gourley, GR, et al. 1992 The effect of diet on feces and jaundice during the first 3 weeks of life. Gastroenterology 103:660-667.
  5. Gourley, GR, et al. 1999 Neonatal jaundice and diet. Arch Pediatr Adolesc Med 153:184-188.
  6. Gourley, GR, et al. 1997 Inhibition of B-glucuronidase by casein hydrolysate formula. J Pediatr Gastroenterol Nutr 25:267-272.