Breast milk jaundice is a type of neonatal jaundice associated with breast milk. The condition usually occurs due to substances in the breast milk that inhibit the body’s ability to breakdown bilirubin, leading to jaundice. Newborns usually develop breast milk jaundice after the first week of life.
Read this post to know about the causes, signs, diagnosis, treatment, and complications of breast milk jaundice in newborns.
What Is Breast Milk Jaundice?
It is essential to understand jaundice before understanding breast milk jaundice. The red blood cells in the body break down periodically and produce a byproduct called bilirubin. The liver processes this bilirubin and prevents its accumulation. However, in some situations, excess bilirubin persists within the body, causing the compound to accumulate in cells of the body. Since bilirubin has a natural yellow color, it causes the distinctive yellowing of the skin and the whites of the eyes. This condition is called jaundice.
The precise cause of breast milk jaundice is not known. It is believed to occur due to breast milk compounds that inhibit certain liver proteins from breaking down bilirubin (1). The condition usually emerges after the first week of the baby’s life (2).
Breast milk jaundice may last for a few weeks in newborns since bilirubin elimination and metabolism is slower due to immature liver functions.
It is different from breastfeeding jaundice, which is a type of neonatal jaundice that occurs due to reduced intake of breast milk for any reason. Unlike breast milk jaundice, breastfeeding jaundice may cause severe dehydration and weight loss in babies (3).
Signs And Symptoms Of Breast Milk Jaundice
- Yellowing of the skin and whites of the eyes
- Trouble latching
- Loss of appetite
- High-pitched cry
- Mild weight loss
- Dark urine
- Pale stools
Consult a pediatrician/ lactation specialist if your baby displays any of these signs and symptoms.
Risk Factors For Breast Milk Jaundice
Genetic factors may increase the risk of breast milk jaundice in babies. A family history of jaundice could also increase the risk of the condition. Beyond the genetic factors, only a few risk factors are considered since the exact cause is unknown (6).
- Delay in milk production
- Poor feeding
- Increased enterohepatic circulation
- Less calorie intake
Not all babies who experience these conditions develop breast milk jaundice, while some babies may develop breast milk jaundice without displaying any of these factors.
Babies are generally more prone to jaundice due to the following reasons (4).
- Babies have more red blood cells than adults. These cells have a shorter life span, causing more bilirubin than the liver can process.
- The immature liver of babies may slowly metabolize the bilirubin.
- If the baby experiences a delay in the passage of meconium (earliest stool), it may increase bilirubin reabsorption in the intestines.
Prevention Of Breast Milk Jaundice
There is no known way to prevent breast milk jaundice in newborns. It is a physiological condition that usually resolves on its own (7).
Diagnosis Of Jaundice
The diagnosis of jaundice can be made from signs and symptoms, such as the yellow discoloration of the skin. Blood tests and analysis of bilirubin levels could help confirm the diagnosis. A blood culture may help exclude possibilities of other infections (8). The doctor/ lactation specialist may also check for breastfeeding habits of the infant to distinguish breast milk jaundice from breastfeeding jaundice.
Additional tests may be ordered to exclude hemolytic disease of the newborn, cephalohematoma, sepsis, urinary tract infection, liver problems, and other conditions that may cause increased bilirubin levels (3).
Treatment For Jaundice
- Phototherapy involves keeping a baby under a special light for one or two days in a hospital. This treatment is usually required for severe jaundice. The light changes bilirubin structure and enhances its elimination from the body. Protective glasses cover the eyes of the newborn to prevent eye damage during phototherapy.
- Increased breastfeeding sessions of eight to 12 times a day could help babies. Excess feeding increases bowel movements and helps the baby get rid of bilirubin through stools.
- Doctors may prescribe formula feeding for some infants since it may help expel excess bilirubin through stools or urine.
- Hospitalization and blood transfusion are needed for babies who have higher levels of bilirubin.
Pediatricians may pick one or multiple treatment options for your baby. Mild breast milk jaundice does not require hospitalization and resolves on its own.
Complications Of Jaundice
Complications are rare in healthy full-term infants with breast milk jaundice. Very high bilirubin levels may result in kernicterus (bilirubin encephalopathy), a type of brain damage due to bilirubin. Kernicterus can damage the brain and nervous system, increasing the risk of problems such as cerebral palsy (4).
Late preterm infants are often at an increased risk of complications than term infants, likely due to hepatic immaturity and other problems.
Prognosis Of Jaundice
The outcome is good in most healthy babies, even if jaundice lasts for a few weeks (10). Careful monitoring helps most babies recover. Usually, breast milk jaundice resolves within a week or two.
Jaundice lasting more than six weeks regardless of adequate treatment and nutrition may require additional tests to identify the cause.
Jaundice seldom causes any lasting problems. You must not stop breastfeeding unless advised by the physician. The benefits of breastfeeding outweigh the risks, and it may even help the baby excrete bilirubin through the increased passage of stools. Adequate care and nutrition will let the baby outgrow the condition safely.
2. Jaundice; CDC
3. Stephanie Bratton, Rebecca M. Cantu, and Mitchell Stern, Breast Milk Jaundice; NCBI
4. Newborn jaundice; NHS UK
5. Jaundice in Newborns (Hyperbilirubinemia); C.S. Mott Children’s Hospital
6. Prashant G Deshpande et al., Breast Milk Jaundice; Medscape
7. Jaundice; La Leche League International
8. What Do You Do For Breast Milk Jaundice?; Pediatric Education
9. Breast milk jaundice; Mount Sinai Health System
10. Breast Feeding and Jaundice; Birth Injury Help Center