Red blood cells
break down at a somewhat higher rate in newborns and some of the
breakdown products have colors. Bilirubin is yellow and often gives
a yellow tinge to the babies eyes and skin. The liver is responsible
for excreting these metabolic "wastes" and it's somewhat
slower to do so in the first days and weeks of life. As a result,
jaundice (also called hyperbilirubinemia or just "hyperbili")
is much more visible. In
extreme situations, hyperbili can stain the brain and damage it
or make babies sleepy, lethargic and prone to under eating and
dehydration. Severe infections often have jaundice as their first
sign. These are rare problems but it is dangerous to ignore the
possibilities.
In the vast, vast
majority of healthy full term babies, mild jaundice is normal
and harmless. Breastfeeding babies get more jaundiced than formula
fed babies and there are some researchers who think this represents
an advantage because bilirubin is a "bacteriostatic"
chemical. That is, it inhibits the growth of infectious bacteria.
Jaundice itself
may not be a problem but increased jaundice may indicate poor
breastfeeding. This is a problem and this is one of the reasons
that the "knee jerk" reaction to jaundice is so dangerous.
Instead of just attempting to change the baby's color from slightly
yellow (or quite yellow) we should be looking much harder at the
reason for the increased bilirubin. Lactation consultation is
usually much more valuable than bilirubin tests and bili lights.
PLEASE REMEMBER,
this information is strictly applicable to healthy full term babies;
preemies and sick kids must be cared for differently and this
is beyond the scope of this brief discussion.
Jaundice may continue
and even increase through the first week or two and if a baby
is doing well, milk is in, nipples are not sore, jaundice is rarely
a problem. If a baby continues to lose weight and jaundice is
increasing, lactation help is needed and closer medical observation
is crucial.
It is almost never
correct to interrupt breastfeeding nor to supplement babies with
mild to moderate jaundice. The disease entity called "Breast
Milk Jaundice" is rare and possibly involves a chemical in
breastmilk which inhibits the metabolism of bilirubin. This jaundice
is longer and more yellow and almost always harmless. Some experts
advocate breastfeeding interruption for a day to help make the
diagnosis in a baby with jaundice beyond week two or three. Many
experts do not recommend this and instead will wait if the baby's
clinical appearance is reassuring.
Jaundice is a normal
condition of babies in the first week of life. Healthy full term
babies who are nursing well, urinating and looking good do not
need intervention. Supplementing with water makes this worse and
supplementing with formula is not necessary and interferes with
breastfeeding success and good health.
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