Breast Feeding Jaundice

1. See Also
   1. Neonatal Jaundice
   2. Risk Score for Neonatal Hyperbilirubinemia
   3. Nonphysiologic Neonatal Jaundice
   4. Breast Feeding Problems for the Infant
   5. Neonatal Bilirubin
2. Pathophysiology
   1. Early Breast Milk Jaundice
      1. Same as mechanism as exaggerated physiologic Jaundice
      2. Related to initial decreased calorie intake
   2. Late Breast Milk Jaundice
      1. Nonesterified long-chain Fatty Acids in Breast Milk
      2. Competitively inhibit glucuronyl transferase
3. Labs
   1. See Neonatal Bilirubin
   2. Early-Onset Breast Milk Jaundice
      1. Same course as exaggerated physiologic Jaundice
      2. Total Bilirubin peaks < 17 mg/dl by day 4 of life
   3. Late-Onset Breast Milk Jaundice
      1. Bilirubin peaks between day of life 6 to 14
      2. Total Bilirubin often 12 to 20 mg/dl
      3. Hyperbilirubinemia may persist 2-3 months
4. Differential Diagnosis
   1. See Neonatal Jaundice Causes
5. Management: Early onset Breast Feeding Jaundice
   1. Encourage mothers to nurse frequently (8-10x per day)
   2. Avoid supplementation if possible
      1. Do not supplement with Glucose or sterile water
      2. Continue Breast Feeding even if supplementing
      3. Formula indicated for inadequate milk production
         1. Poor weight gain
         2. Delayed stooling (and delayed transition to seedy mustard-colored stools by day 3-4 of life)
         3. Less than 4 wet diapers daily
   3. Monitor Serum Bilirubin daily as outpatient
      1. See Phototherapy Indications
   4. Mothers may express milk after feedings
      1. Increases milk volume
6. Management: Late onset Jaundice (Bilirubin 17-20 mg/dl)
   1. Diagnosis
      1. Interrupt Breast Feeding for 24-48 hours
      2. Express milk regularly to maintain production
      3. Monitor Serum Bilirubin levels every 12-24 hours
      4. Anticipate Bilirubin decrease of 3 mg/dl per day
   2. Resume Breast Feeding after decreased Serum Bilirubin
   3. Confirms Breast Feeding Jaundice
7. References
   1. Gartner (2001) Pediatr Clin North Am 48(2):389-99 [PubMed]
   2. Muchowski (2014) Am Fam Physician 89(11): 873-8 [PubMed]