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This is the yellow colour of the skin and mucous membranes which is visible in 84% of newborns, due to the increase of bilirubin in blood serum (Gartner 2001, Muchowski 2014).
Several studies have shown a higher frequency of jaundice in breastfed infants, being a frequent cause of misplaced discontinuation of breastfeeding (Bertini 2001, Waite 2016), as well as its beneficial effect due to the anti-oxidant action of bilirubin, just after childbirth, when there is a risk of oxidative stress due to the higher concentration of oxygen in the extrauterine environment than in the intrauterine environment. The toxicity to tissues of oxygen at high doses is known (Hammerman 1998, Fereshtehnejad 2012).
Traditionally, a toxic effect on the brain, known as Bilirubin Encephalopathy (BE) or Kernicterus, has been attributed to high levels of bilirubin, due to deposits of bilirubin in the basal ganglia (AAP Subcommittee 2004), although its inner molecular mechanism in humans is unknown.
Serious epidemiological studies with rigorous methodology have shown:
1. Low BE rates (0.4-0.6 per 100,000 births).
2. All cases which were studied were associated with risk factors (prematurity, hemolysis, glucose deficiency 6-phosphate dehydrogenase, serious infection).
3. There were no cases of BE below 35 mg/dL of bilirubin.
4. In no case does the fact of being breastfed appear as a risk factor (Ebbesen 2012, Vandbord 2012, Kuzniewicz 2014, Wu 2015). Moreover, one of the authors concludes that the concept of BE as a preventable entity in all cases, should be reviewed (Newman 2015).
There is doubt around the advisability of carrying out universal bilirubin screening in newborns, as it is not without risk (Grosse 2019).
Often, the cause of the increase in bilirubin is due to delay in the onset of breastfeeding, infrequent feeds or oral administration of glucose serum, which favours the absorption of bilirubin contained in meconium (Yamauchi 1990, Gartner 2001).
Accordingly, the frequent practice of discontinuing breastfeeding of newborns with jaundice is misplaced (Flaherman 2017), as is beginning any treatment with bilirubin values below 25 mg/dL after 72 hours of life and if not accompanied by the aforementioned risk factors (Newman 2015).