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In the first few weeks of life there are many causes of jaundice (a yellow skin colour caused by high levels of bilirubin).
These range from the normal 'physiological' jaundice seen in many babies, both breast- and bottle-fed, to abnormal jaundice from various conditions. Abnormal jaundice can be serious if not treated properly. The diagnosis depends on the time of onset of the jaundice and on blood tests. Only a few full-term jaundiced babies need treatment and whether it's necessary depends on the type of jaundice and the bilirubin level. Babies with slightly raised bilirubin levels for whatever reason are often treated with phototherapy /light therapy. They are placed naked for short times in a cot beneath a strong blue light, with their eyes covered with a mask. Some hospitals place babies on special blankets that emit blue light. Light therapy may hinder frequent and unrestricted breastfeeding, but if the nurses agree, you can take your baby from under the light when you want to feed him.
If your baby is otherwise well, the paediatrician may agree to your taking him home and giving him daylight phototherapy. The advantage of being at home is you can breastfeed much more easily.
This follows the normal breakdown of red blood cells in a newborn baby, appears on the second to fourth day of life and usually disappears by about a week. This early-onset jaundice is less likely in babies breastfed soon after birth and on a frequent and unrestricted basis, but the fewer feeds a baby has, the more likely he is to have jaundice. All that many physiologically jaundiced babies need is more breast milk. You can arrange this by feeding more often and for longer so as to increase your milk supply. One expert says 10-12 breastfeeds a day is the minimum number for reducing the risk of jaundice.
Colostrum helps a baby's bowel get rid of meconium - the first bowel motions which contain a lot of bilirubin. If meconium isn't excreted quickly it can be reabsorbed into the bloodstream. Frequent breastfeeds help get rid of it more quickly. Giving an infant water isn't helpful and may interfere with his mother's milk supply. This is because he'll want fewer breastfeeds if his tummy is full with water.
Breast Milk Jaundice
Some healthy breastfed babies become jaundiced a little later, towards the end of the first week of life. One or two in every hundred breastfed babies develop this 'breast milk jaundice'. It is worst during the second to third week and lasts from 4-16 weeks. There's considerable evidence that breast milk jaundice has no serious long-term effects.
A jaundiced baby is usually sleepy, making feeding difficult so it's really important to breastfeed a little and often. If your baby is reluctant to breastfeed, milk can be expressed and given to the baby using a spoon or cup. Your baby won't need to use too much of his energy on actually feeding then. You can still offer the breast for short periods, and express inbetween. You certainly don't need to give formula feeds, as long as enough expressed breast milk is collected.
Don't give any extra fluids to help flush the baby's system. The priority with jaundiced babies is to provide the baby with sugars for energy and proteins to bind with bilirubin. Your breastmilk contains all these ingredients in perfect proportions. By breastfeeding, the levels of bilirubin can be reduced quickly and turned into safe waste products that can then be excreted in the baby's urine and stools. This, along with phototherapy should be enough for most babies.
Babies with abnormal jaundice look yellow at birth or within 24 hours. Whatever treatment is necessary, they need early, frequent and unrestricted breastfeeds for the reasons outlined above.
Dr. Penny Stanway
YOU CAN BUY DR.STANWAY'S BOOK 'BREAST IS BEST' HERE
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