Almost all newborns develop jaundice, but many parents don’t know much about this common condition. How is jaundice diagnosed? Why do babies get jaundice? Why do some babies need to be treated while some don’t? Can you breastfeed if your baby has jaundice? Is breastfeeding jaundice dangerous? Hopefully I can answer some of these questions.
Jaundice is the accumulation of the pigment bilirubin in the blood. Before babies are born they have a high red blood cell count, because the oxygen environment is less rich before birth. After birth the baby will breakdown the red blood cells it doesn’t need, and that process will release bilirubin. In addition to this process, the newborn’s liver is not mature enough to adequately clean the bilirubin out of the blood. By the end of the first week of life the liver is functioning almost normally. This liver function is why premature babies are at a higher risk of having the bilirubin spill into the brain, which can be devastating. There is an enzyme in the liver that cleans the bilirubin from the blood, and at 36 weeks gestation it is working at 1/100th of the level that a normal liver is working at.
Most parents will notice that their baby looks a little yellow in their skin tone at about 2 days of life, and that color will peak at about 5-6 days of life. A baby with a low level of jaundice will be a little yellow in their face, but a baby with high bilirubin will be yellow down to their thighs, or below. Jaundice is typically diagnosed by a heel stick, or TCB (transcutaneous bilirubin, a noninvasive device that can measure bilirubin through the skin of the forehead). The number is then compared to the baby’s age on a chart to determine the risk level. This risk level is to prevent a condition called bilirubin encephalopathy. When the levels of bilirubin get too high in the blood, it can cross the blood brain barrier, having devastating effects on the brain. No one is sure what that level is, so the goal is to prevent the level from getting too high. If your baby plots out at low risk on the chart, then your baby is at a low risk of developing bilirubin encephalopathy. If your baby is at a high risk, then your doctor will probably recommend treatment. Thankfully, most jaundice is easily treated with UV lights. In rare cases phototherapy is insufficient, and then jaundice can be treated with an exchange transfusion, but that is extremely rare.
Bilirubin is mostly secreted out of the stool, sometimes turning it green in color. Because it is secreted through the stool, feeding your baby will help the jaundice reduce. And that is where breastfeeding jaundice comes in. If your baby has severe jaundice then you may think that you can’t breastfeed, but that is untrue. Breastfed babies will be jaundiced longer, but a low level of bilirubin in the blood is harmless to your baby. It is only the very high levels that can be dangerous, and those can be treated with UV lights. It is not abnormal for a breastfed baby to have jaundice for weeks, or even months, but it is not harmful. So, if your baby has jaundice, you can breastfeed! If jaundice is very severe, then supplementation may be helpful (although probably not needed), but jaundice won’t prevent you from being able to breastfeed.
Some babies are at a higher risk of bilirubin encephalopathy than others. Premature infants are at a higher risk because of the liver function that I mentioned earlier. Babies born to women who are Rh sensitized are another high risk group. This is why rhogam is recommended for women who are a negative blood type, but are married to a positive blood type father. However, there are many more Rh factors than + and -, but that is beyond this article (I happen to be sensitized to anti-E). Another risk factor is ABO incompatibility. If the mother’s blood type is O and the father’s is A, B or AB, then the baby is at a higher risk of jaundice. Asian babies also have a higher risk of jaundice that needs to be treated, but no one is sure why.
I hope that this has given you some information about a very common newborn condition. All three of my kids have had varying levels of jaundice. My first was born premature and had levels spike up to nearly 22 on her 4th day of life. My second had very similar numbers because I developed an Rh sensitivity, and my third had low levels of jaundice that did not need to be treated. So this is a topic that is close to my heart, and I hope it has been informative.