Last update Feb. 11, 2020

Neonatal Jaundice

Very Low Risk

Safe. Compatible. Minimal risk for breastfeeding and infant.

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).

Suggestions made at e-lactancia are done by APILAM team of health professionals, and are based on updated scientific publications. It is not intended to replace the relationship you have with your doctor but to compound it.

Jose Maria Paricio, Founder & President of APILAM/e-Lactancia

Your contribution is essential for this service to continue to exist. We need the generosity of people like you who believe in the benefits of breastfeeding.

Thank you for helping to protect and promote breastfeeding.

José María Paricio, founder of e-lactancia.

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References

  1. Grosse SD, Prosser LA, Botkin JR. Screening for Neonatal Hyperbilirubinemia-First Do No Harm? JAMA Pediatr. 2019 May 20. Abstract
  2. Flaherman VJ, Maisels MJ; Academy of Breastfeeding Medicine.. ABM Clinical Protocol #22: Guidelines for Management of Jaundice in the Breastfeeding Infant 35 Weeks or More of Gestation-Revised 2017. Breastfeed Med. 2017 Jun;12(5):250-257. Abstract
  3. Waite WM, Taylor JA. Phototherapy for the Treatment of Neonatal Jaundice and Breastfeeding Duration and Exclusivity. Breastfeed Med. 2016 May;11:180-5. Abstract
  4. Wu YW, Kuzniewicz MW, Wickremasinghe AC, Walsh EM, Wi S, McCulloch CE, Newman TB. Risk for cerebral palsy in infants with total serum bilirubin levels at or above the exchange transfusion threshold: a population-based study. JAMA Pediatr. 2015 Mar;169(3):239-46. Abstract
  5. Muchowski KE. Evaluation and treatment of neonatal hyperbilirubinemia. Am Fam Physician. 2014 Jun 1;89(11):873-8. Review. Abstract
  6. Kuzniewicz MW, Wickremasinghe AC, Wu YW, McCulloch CE, Walsh EM, Wi S, Newman TB. Incidence, etiology, and outcomes of hazardous hyperbilirubinemia in newborns. Pediatrics. 2014 Sep;134(3):504-9. Abstract
  7. Fereshtehnejad SM, Poorsattar Bejeh Mir K, Poorsattar Bejeh Mir A, Mohagheghi P. Evaluation of the possible antioxidative role of bilirubin protecting from free radical related illnesses in neonates. Acta Med Iran. 2012;50(3):153-63. Abstract
  8. American Academy of Pediatrics Subcommittee on Hyperbilirubinemia.. Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation. Pediatrics. 2004 Jul;114(1):297-316. Erratum in: Pediatrics. 2004 Oct;114(4):1138. Abstract
  9. Gartner LM. Breastfeeding and jaundice. J Perinatol. 2001 Dec;21 Suppl 1:S25-9; discussion S35-9. Abstract
  10. Bertini G, Dani C, Tronchin M, Rubaltelli FF. Is breastfeeding really favoring early neonatal jaundice? Pediatrics. 2001 Mar;107(3):E41. Abstract
  11. Hammerman C, Goldstein R, Kaplan M, Eran M, Goldschmidt D, Eidelman AI, Gartner LM. Bilirubin in the premature: toxic waste or natural defense? Clin Chem. 1998 Dec;44(12):2551-3. No abstract available. Abstract
  12. Yamauchi Y, Yamanouchi I. Breast-feeding frequency during the first 24 hours after birth in full-term neonates. Pediatrics. 1990 Aug;86(2):171-5. Abstract

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