By Dr Ananya Mandal, MD
Jaundice in the newborn baby is caused by an excess of bilirubin.
Bilirubin in the blood is usually present in very small amounts. It contains the breakdown components of red blood cells. Normally the gut removes the bilirubin that is formed by the liver.
In the newborn period, bilirubin can build up faster than the body can remove it.
Symptoms of jaundice
Jaundice may appear as yellowing of the skin and eyes. Most newborn babies are affected to some degree between the second and third day of life.
By two weeks of age this may clear up on its own without treatment. This is called physiological jaundice. This means there is not underlying disorder or disease.
Jaundice usually starts at the head and spreads towards the feet as it gets worse. Jaundice in the newborn is not contagious.
Types of jaundice
There are two types of jaundice can affect breastfed infants. One is the breastfeeding jaundice and the other is breast milk jaundice.
Breastfeeding jaundice occurs when a breastfeeding baby is not getting enough breast milk. This occurs if the mother’s milk has not yet come in or the mother is unable to feed the baby yet not having mastered correct breastfeeding techniques. This is not caused by a problem with the breast milk itself.
Breast milk jaundice is caused by substances in the mother’s milk that can prevent bilirubin from being excreted from the body. This is seen in some healthy, breastfed babies after about one week of age. This type of jaundice may last for a month or more and it is usually not harmful.
Diagnosis and treatment
Jaundice is diagnosed based on symptoms and appearance. The level of bilirubin is monitored in blood using tests.
Breast milk jaundice is not an indication for stopping breastfeeding. The mother is advised to treat this type of jaundice by breastfeeding more frequently or for longer periods of time.
She may seek the help of a lactation consultant to help the baby latch on correctly and remove milk adequately. If milk taken by the baby is inadequate, as is seen in small for weight and premature babies, milk may be expressed by hand and given to the baby. This is used to treat breastfeeding jaundice.
The baby may also be given formula if the mother’s milk is taking a couple of days to come in. Breastfeeding may be reinstated after the milk comes in.
The mother should be explained that breastfeeding is best for the baby and it is not the breast milk that is causing the jaundice. Breast milk jaundice cannot be prevented.
Babies with more severe jaundice may require phototherapy. This means the baby is placed under special lights. This light helps break down bilirubin into a form that can be removed from the baby’s body easily.
Those with milder physiological jaundice may be placed near the window to receive sunlight. However, babies have very delicate skin and should not be exposed to the direct sunlight for long durations.
Reviewed by April Cashin-Garbutt, BA Hons (Cantab)