Jaundice causes the whites of eyes and skin to turn yellowish. Jaundice occurs when an excess amount of bilirubin circulating in the bloodstream dissolves in the layer of fat just beneath the skin.
Breast milk Jaundice
Breast milk Jaundice is a common type of Neonatal jaundice that occurs due to optimal breast milk. It commonly occurs in the first week of life. It is different from Breast-Feeding Jaundice. Breast Feeding Jaundice occurs due to the lactase of breast milk. In contrast, It occurs due to the accumulation of some substances present in the mother’s breast milk. The etiology or the leading cause of breast milk jaundice is still unknown.
These substances present in breast milk block the protein in the liver responsible for breaking the bilirubin. Bilirubin is a yellow substance that is thatched by the breakdown of red blood cells. Normally, bilirubin gets rid of the liver. But in neonates, the liver is not well mature and sometimes cannot clear the bilirubin in the blood, so it settles down into the skin. When the total serum bilirubin level rises, a yellow discolouration of skin in the eye (white part) occurs.
What are the substances present in breast milk that cause Breast milk jaundice?
However, it does not mean something is wrong with mother’s milk. It is believed that it may be linked to some substances present in breast milk that block the breakdown of bilirubin. A high level of Beta – Glucuronidase in the breast milk de-conjugates the intestinal bilirubin and increases enterohepatic circulation. An enzyme in the breast milk called lipoprotein lipase produces an increased concentration of non-esterified free fatty acids that inhibit hepatic glucuronyl transferase, which again leads to decreased conjugation and subsequent excretion of bilirubin. It has been suggested that bilirubin uptake in the intestine increases in breastfed babies, possibly due to increased epidermal growth factors (EGF) in breast milk.
Breast Milk Jaundice is a rare condition. It affects only 1-2 per cent of infants. Most babies who present with true Breast Milk Jaundice may see another rise in bilirubin level at about 14 days. It is safe to continue breastfeeding because it disappears independently, and the bilirubin level will eventually decrease. Breast milk Jaundice may last for 2-12 weeks after birth. Still, as long as the baby is feeding well and bilirubin levels are monitored regularly because it is a type of Neonatal jaundice, so all symptoms of jaundice will occur.
What are the common symptoms seen in Breast Milk Jaundice infected babies?
• The infant’s skin colour changes to yellow. A lemon yellow or orange-yellow colour appears on the face, chest and, upper and lower abdomen, both upper and lower extremities ( arms and legs)
• The white part of both eyes turns yellowish.
• A yellow colour appears under the tongue.
• Yellow colour of urine present.
• Extremely tiredness or fatigue
• Extreme sleep.
• High pitch cry
• Poor weight gain
Genetic or family history of Breast Milk Jaundice may increase the risk. But we should not stop breastfeeding.
How can Breast Milk Jaundice be diagnosed?
If we see the above symptoms in newborn babies within the first week of life, we must contact our consultant or Pediatrician. The consultant will observe the findings to ensure that the baby latches correctly and get sufficient breast milk. Many hospitals have lactation consultants who teach or train the mothers to feed their babies. If your baby is latching onto the breast well and getting optimal milk, the consultant can diagnose it as Breast Milk Jaundice, depending on the symptoms.
There are some blood tests to confirm the diagnosis. Your doctor or consultant will ask you for some tests. These tests are
• Total Serum Bilirubin (TSB) level- High level of bilirubin indicates jaundice.
• CBC (Complete Blood Count)
• Direct or Indirect Coomb’s Test
• Reticulocyte Count
Breast milk jaundice treatment
First, we must understand that Breast Milk Jaundice is not harmful. It can go away by itself within one or two weeks if the baby’s liver becomes more efficient and the baby continues to take adequate amounts of breast milk. Babies with Breast Milk Jaundice usually recover with the proper treatment and careful monitoring.
Yes, we should take care of the baby while latching the breast milk so that the baby is taking optimal milk. But do not stop breastfeeding. If we stop breastfeeding, the baby can get Breast Milk Jaundice, which can be caused by intake of insufficient amount of breast milk. Keep the baby hydrated. Do not leave the baby wet. If we see the baby’s skin colour turn yellow, we must have the baby’s bilirubin level checked. If the bilirubin level is high, it is essential to ensure no other medical problems.
In rare cases, jaundice may persist past the sixth week of life, even with the proper treatment, and this can give a clue to an underlying medical condition that needs more aggressive treatment. Consult your doctor or health caretaker regularly.
What is the Treatment done by your Doctor or consultant?
Treatment is usually not required.
Jaundice is not a permanent condition. Spontaneous resolution usually occurs within 12 weeks of age. So we should not discontinue breastfeeding the baby.
Your doctor may advise you to breastfeed your baby more frequently or give some additional formula with breast milk. It will help your baby to clear.
The bilirubin in their urine or stool.
For high excess bilirubin, Phototherapy is the option for the physician, but it is a rare condition. Phototherapy helps your baby’s liver get rid of excess bilirubin. The lights won’t harm your baby. These lights will break the bilirubin and pass it out through the urine or stool.
Phototherapy treatment takes one to two days. The infant is placed under these lights in a warm, enclosed bed to maintain a constant temperature. The baby will wear only a diaper and unique shades to protect the eyes. Breastfeeding should be continued during phototherapy. Massage therapy could be helpful in addition to phototherapy to reduce the phototherapy duration. However, it does not appear to reduce the requirement for phototherapy in the treatment of jaundice.
If your baby’s bilirubin levels aren’t too high, you may be able to treat your baby with light therapy at home.
Points to be remember
• Breast Milk Jaundice is a low condition and not harmful.
• It occurs in a neonate due to intake of optimal breast milk.
• Yellow discolouration occurs on the baby’s chest and extremities, and the white colour of the eyes (sclera) changes into yellow
• Usually, it will go away by itself after 2 or 3 weeks. So, no need to be scared.
• Bilirubin levels may arise due to some substances in breast milk.
• Regularly monitor the bilirubin level under the observation of your consultant.
• Sometimes or in rare cases, Phototherapy can be chosen by the physician to treat if the bilirubin level goes higher.
