jaundice

[Guest guest]

I'm giving a lot of information here. Jaundice can be very confusing

and I wanted to understand it better myself. It's also hard in a

country like the US that is not very supportive of breastfeeding,

generally, to know when we can trust information that says we might

have to supplement. I am paraphrasing/summarizing the following

from La Leche League's Breastfeeding Answer Book.

 

There are two categories of jaundice:

 

1) Pathological jaundice is is evidenced by high or or rapidly rising

bilirubin levels evident at birth or within the first day or two and is

most likely do to a problem unrelated to feeding. If bilirubin levels

are rising rapidly, the baby may need immediate treatment. There

are many possible causes for pathological jaundice. Some

examples are Rh or ABO blood incompatabilities, gastrointestinal

obstructions, liver enzyme-deficiency diseases, infections, and

metabolic problems, which could possibly include galactosemia.

 

With the exception of the baby with galactosemia, frequent

breastfeeding (10 to 12 times a day) can and should continue

during the treatment of pathologic jaundice. Frequent nursing will

help speed the elimination of bilirubin.

 

A baby with galactosemia is an extremely rare child who cannot be

breastfed. Besides high bilirubin counts, galactosemia has many

other obvious symptoms (including vomiting, diarrhea, failure to

thrive, etc.) and can be tested for by a blood test., but one should

be aware that blood tests for galactosemia produce many false-

positive results, especially in the summer.

 

2) Physiologic jaundice usually starts the second to fifth day,

generally peaking the third or fourth day, after birth. More than half

of all newborns experience this jaundice, which is why it is called

" physiologic, " meaning normal. This condition is temporary and

normally resolves itself within a few days or weeks without

treatment. Some health care professionals recommend interrupting

breastfeeding to bring down bilirubin levels, although this is not

necessary. Supplementing breastfeeding with formula, however,

may be needed if the mother's milk supply is low and bilirubin levels

become exaggerated.

 

Early and frequent breastfeeding will prevent physiologic jaundice

from becoming exaggerated. One study found that a minimum of

nine nursings every twenty-four hours may prevent normal newborn

jaundice from becoming exaggerated. Babies who nursed seven to

eleven times per day from birth were found to consume substatially

more milk than babies who nursed six or fewer times.

 

When a jaundiced baby is feeding frequently and effectively,

physiologic jaundice will resolve on its own without intervention. It is

not a disease, it is a harmless condition that has no aftereffects,

provided the baby's bilirubin does not reach unsafe levels. Some

experts have suggested that research should be done to determine

if elevated bilirubin is beneficial to the newborn.

 

If a baby is growing but still jaundiced at 2-3 weeks of age, the

doctor may want to do tests to rule out causes of pathologic

jaundice. Once that has been ruled out, treatment is not usually

necessary and the jaundice will eventually clear on its own without

aftereffects, although in some cases it may take as longa s three

months.

 

Although it rarely occurs today, excessive bilirubin can cause

kernicterus, or brain damage, which is why it may need to be treated

when levels rise high or rapidly.

 

Ways of dealing with mild to moderate jaundice on one's own

include frequent breastfeeding, waking the baby to nurse if

necessary, encouraging the baby to receive more hindmilk to

encourage stooling (at least two per day by third day of life),

exposing the baby to indirect sunlight, and avoiding water

supplements. If these don't work and the bilirubins are

exaggerated, the doctor may want to try phototherapy. In the case

where the baby does not seem to be able to get enough milk from

breastfeeding (as evidenced by too few stools, wet diapers, low

weight gain), supplementing may actually be advised for one or two

days, but it doesn't have to be done with an artificial nipple.

 

To the woman who is worried about jaundice, I highly recommend

that you get the support of your local La Leche League leader. She

will have information at her fingertips (I only gave you a small

amount of what is written in the Breastfeeding Answer Book) and

may be able to give you suggestions on how to best deal with your

doctor. Most of all, this is a difficult time, and the friendship and

support of another breastfeeding mother is nearly essential!

http://www.lalecheleague.org/ can help you get in touch with a leader.

 

And congratulations on your new baby!

 

Deirdre