eMedicine Specialties > Pediatrics: Cardiac Disease and Critical Care Medicine > Neonatology
Breast Milk Jaundice: Treatment & Medication
Updated: Oct 23, 2009
- Overview
- Differential Diagnoses & Workup
- Treatment & Medication
- Follow-up
- Multimedia
Treatment
Medical Care
- Treatment recommendations in this section apply only to healthy term infants with no signs of pathologic jaundice and are based on the severity of hyperbilirubinemia. In preterm, anemic, or ill infants and those with early (<24 h) or severe jaundice (>25 mg/dL or 430 µmol/L), different treatment protocols should be pursued (see Jaundice, Neonatal).
- For healthy term infants with breast milk or breastfeeding jaundice and with bilirubin levels of 12 mg/dL (170 µmol/L) to 17 mg/dL, the following options are acceptable:
- Increase breastfeeding to 8-12 times per day and recheck the serum bilirubin level in 12-24 hours. The mother should be reassured about the relatively benign nature of breast milk jaundice (BMJ). This recommendation assumes that effective breastfeeding is occurring, including milk production, effective latching, and effective sucking with resultant letdown of milk. Breastfeeding can also be supported with manual or electric pumps and the pumped milk given as a supplement to the baby.
- Continue breastfeeding and supplement with formula.
- Temporary interruption of breastfeeding is rarely needed and is not recommended unless serum bilirubin levels reach 20 mg/dL (340 µmol/L).
- For infants with serum bilirubin levels from 17-25 mg/dL (294-430 µmol/L), add phototherapy to any of the previously stated treatment options. The reader is referred to the American Academy of Pediatrics' practice parameter on the management of hyperbilirubinemia in healthy full-term newborn infants.8
- The most rapid way to reduce the bilirubin level is to interrupt breastfeeding for 24 hours, feed with formula, and use phototherapy; however, in most infants, interrupting breastfeeding is not necessary or advisable.
- Phototherapy can be administered with standard phototherapy units and fiberoptic blankets.
The graph represents indications for phototherapy and exchange transfusion in infants (with a birthweight of 3500 g) in 108 neonatal ICUs. The left panel shows the range of indications for phototherapy, whereas the right panel shows the indications for exchange transfusion. Numbers on the vertical axes are serum bilirubin concentrations in mg/dL (lateral) and mmol/L (middle). In the left panel, the solid line refers to the current recommendation of the American Academy of Pediatrics (AAP) for low-risk infants, the line consisting of long dashes (- - - - -) represents the level at which the AAP recommends phototherapy for infants at intermediate risk, and the line with short dashes (-----) represents the suggested intervention level for infants at high risk. In the right panel, the dotted line (......) represents the AAP suggested intervention level for exchange transfusion in infants considered at low risk, the line consisting of dash-dot-dash (-.-.-.-.) represents the suggested intervention level for exchange transfusion in infants at intermediate risk, and the line consisting of dash-dot-dot-dash (-..-..-..-) represents the suggested intervention level for infants at high risk. Intensive phototherapy is always recommended while preparations for exchange transfusion are in progress. The box-and-whisker plots show the following values: lower error bar = 10th percentile; lower box margin = 25th percentile; line transecting box = median; upper box margin = 75th percentile; upper error bar = 90th percentile; and lower and upper diamonds = 5th and 95th percentiles, respectively.
- Fiberoptic phototherapy can often be safely administered at home, which may allow for improved infant-maternal bonding.
- Although sunlight provides sufficient irradiance in the 425-nm to 475-nm band to provide phototherapy, practical difficulties involved in safely exposing a naked newborn to sunlight, either indoors or outdoors (and avoiding sunburn), preclude the use of sunlight as a reliable phototherapy tool; therefore, it is not recommended.
- Phototherapy can be discontinued when serum bilirubin levels drop to less than 15 mg/dL (260 µmol/L).
- Average bilirubin level rebound has been shown to be less than 1 mg/dL (17 µmol/L); therefore, rechecking the level after discontinuation of phototherapy is not necessary unless hyperbilirubinemia is due to a hemolytic process.
- For an in-depth discussion of phototherapy, see Jaundice, Neonatal.
Consultations
- Consider consultation with a neonatologist when serum bilirubin level approaches 20 mg/dL (430 µmol/L) or when signs and symptoms suggest pathological jaundice and the rate of rise in the serum bilirubin level is more than 0.5 mg/dL/h.
- A consultation with a lactation specialist is recommended in any breastfed baby who has jaundice. The expertise of lactation consultants can be extremely helpful, especially in situations in which inadequate breastfeeding is contributing to the jaundice.
Diet
- Continue breastfeeding, if possible, and increase frequency of feeding to 8-12 times per day.
- Depending on maternal preference, breastfeeding can be supplemented or replaced by formula at the same frequency. Supplementation with dextrose solution is not recommended because it may decrease caloric intake and milk production and may consequently delay the drop in serum bilirubin concentration. Breastfeeding can also be supplemented by pumped breast milk.
Activity
- No restrictions are necessary.
- Encourage parents to remove the child from the warmer or infant crib for feeding and bonding. Fiberoptic blankets allow holding and breastfeeding without interruption in treatment.
Medication
- Medication is not currently a component of care in this condition. See Treatment.
More on Breast Milk Jaundice |
| Overview: Breast Milk Jaundice |
| Differential Diagnoses & Workup: Breast Milk Jaundice |
 Treatment & Medication: Breast Milk Jaundice |
| Follow-up: Breast Milk Jaundice |
| Multimedia: Breast Milk Jaundice |
| References |
| « Previous Page | Next Page » |
References
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Further Reading
Keywords
breast milk jaundice, jaundice, neonatal jaundice, indirect bilirubin, bilirubin, breastfeeding, physiologic jaundice, uridine diphosphoglucuronic acid, UDPGA, UDPGA glucuronyl transferase, unconjugated bilirubin pigment, conjugated bilirubin, hyperbilirubinemia, clinical jaundice, cholestatic jaundice, bilirubin level, pathologic jaundice, phototherapy, breast milk, breastfeeding-associated jaundice, Gilbert syndrome, kernicterus
