Neonatal Jaundice and Infant Feeding
In a few words, the fetus receives red blood cells (hence oxygen) via the placenta. When the fetus is born and starts breathing, the red blood cells multiply and therefore the body has to destroy a number of them that is not needed. The result of the breakdown of red blood cells is the production of bilirubin, which is responsible for the yellow skin of the babies with jaundice.
Jaundice is a common and physiological situation. It affects 60% of full-term babies, 80% of preterm babies, while 5% of these babies will require phototherapy. Many women face a paradox when they are told that breastfeeding is the best start for their baby’s life and at the same time they hear that breastfed babies will develop jaundice more often.
Two common types of jaundice will now be explained that confuse and worry many parents.
The first type of jaundice is “breast-milk jaundice”, that appears between the 1st and 3rd week of life in healthy babies that breastfeed well. The cause has not been identified yet, but it might be due to specific proteins in breast milk that hinder the destruction of bilirubin in the baby’s body. The second type of jaundice is “breastfeeding jaundice”, that occurs between the 2nd and 3rd day of life if the baby does not get enough breast milk.
According to the official guidelines, in case of jaundice breastfeeding can usually continue. Ideally, the woman will breastfeed longer and more often, in order for the baby to get rid of the bilirubin via the stools. Formula milk is recommended if breastfeeding has not been stimulated, in case of insufficient expressed breast milk, dehydration and severe weight loss of the baby. It has been shown that routine administration of formula milk, either as a supplement or replacement of breast milk, might lead to early breastfeeding discontinuation.
Phototherapy might also affect breastfeeding. Research and official guidelines underline that phototherapy can stop temporarily in order for the baby to breastfeed, unless the bilirubin levels are extremely high. Generally, hospitalisation of the baby and their separation from their mothers for blood testing or phototherapy might make their bonding and breastfeeding more difficult. Many mothers of babies with jaundice express feelings of guilt, failure and inadequacy. Not only the way a mother reacts, but also the way in which she interprets and understands the information she is given are determinant factors in infant feeding. Therefore, it is very important for parents to be appropriately informed, encouraged and continuously supported in breastfeeding, if the mother wishes to do it.
If you have any concerns regarding neonatal jaundice or feeding your baby, do not hesitate to contact and ask for help from a midwife you trust.
Eleni Asimaki, Midwife, MSc, Certified KG Hypnobirthing Instructor
- NICE. Jaundice in newborn babies under 28 days, Clinical guideline [CG98], https://www.nice.org.uk/guidance/cg98/chapter/Recommendations (updated October 2016).
- NICE. Addendum to Jaundice in newborn babies under 28 days, Clinical Guideline 98.1 https://www.nice.org.uk/guidance/cg98/evidence/addendum-pdf-2490921037 (Published on May 2016).