Breast milk jaundice

Definition

Breast milk jaundice is persistent jaundice in the newborn, caused by certain enzyme inhibitors found in the breast milk. It occurs after the first week of life and may continue up to the sixth week of life in otherwise healthy and exclusively breast-fed infants.

Causes, incidence, and risk factors

Jaundice is a yellowish tinge to the skin and/or eyes. Jaundice in a newborn (neonatal jaundice) is a common and normal occurrence caused by excess bilirubin (a breakdown product of hemoglobin made by the liver).

All babies have some degree of jaundice. Breast-fed babies often have more severe jaundice. This is known as "breast feeding jaundice." While there is no scientific proof, some experts think this exaggerated jaundice provides the baby with antioxidant effects, protecting the infant from tissue injury or disease.

If the jaundice occurs or persists past the first week in an otherwise healthy and thriving breast-fed infant, this condition is called "breast milk jaundice." The cause is thought to relate to factors in the breast milk itself which inhibit certain enzymes in the liver.

Breast milk jaundice does tend to run in families. It is seen equally in males and females and affects approximately 0.5% to 2.4% of live births.

Symptoms

The symptom is prolonged jaundice in a healthy, breast-fed newborn, beginning after the first week of life and continuing up to the sixth week of life.

Signs and tests

• blood test for bilirubin (total and direct)
  
• complete blood count (with smear)
  
• reticulocyte count
  
• blood type
  
• test for G6PD (in some populations)
  

Treatment

Treatment will depend on the bilirubin level. In general, more frequent nursing (up to 12 times a day) will decrease the bilirubin level. If the bilirubin level is worrisome (greater than 20 mg/dL), a mother can stop nursing for 24 to 48 hours, which will result in a rapid drop of bilirubin.

She can express the milk or pump her breasts (to maintain comfort and the flow of milk) and bottle feed the baby in the interim. When nursing is re-started, the bilirubin will not return to previous levels. Other measures, such as phototherapy, may be necessary with bilirubin levels greater than18 mg/dL (or if bilirubin levels are lower but rapidly increasing).

Expectations (prognosis)

Full recovery is expected with appropriate monitoring and treatment.