My baby is jaundiced and seems too sleepy to feed. Why is this and how can breastfeeding help?
In order to understand why your baby is sleepy, you need to know the causes and treatment of jaundice itself.To provide extra oxygen during the stressful period of labour and birth, a baby's blood contains many more red blood cells than usual. In the first few days after birth, these red blood cells are broken down in the reticuloendothelial system (liver, spleen and bone marrow). The resultant waste product called bilirubin rises and is the cause of the yellow skin your baby displays. This is called jaundice and can even the white of the eye can become discoloured. Following various chemical processes the baby combines the bilirubin with proteins so that it can be safely excreted via the liver and kidneys.
Physiological jaundice, as it is known, is very common and affects about 30% of all babies. It occurs around the 3rd day and is usually clear by the 10th-14th day, without any long-term consequences. Jaundice is observed using simple colour charts and if the colour deepens, a heel prick blood test will be carried out. This is called a serum bilirubin (SBR). Serum bilirubin levels are checked once or twice daily and as long as they do not rise above 250-300 mmol/litre no treatment is required. Each hospital will have in place a set of guidelines that are followed in order to highlight any potential problems.
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If levels rise above this, there can be a risk of brain damage, which is why it is so important to monitor bilirubin levels regularly. Phototherapy helps to speed the process of bilirubin breakdown, thus bringing it back to normal.
Phototherapy consists of a set of fluorescent strip lights that provide blue light. This is either placed over the cot/incubator or as a mattress (called a bilibed) that the baby lies on top of. The baby is nursed naked and fed frequently to provide the necessary energy and protein. Extra care is needed to reassure the mother that this is a short-term process that will hopefully resolve the problem.
If levels rise further and are not helped by phototherapy, there may be a need to investigate the cause. An exchange transfusion of blood may be required in this instance. However these complications are very rare and the most important point to remember is the commencement of early feeding.
Breastfeeding not only provides the baby with the energy and proteins that are needed for the breakdown processes, but also aids the efficient removal of the first stools through the gut, thus allowing for the excretion of the by products of the bilirubin breakdown.
As a consequence of all these chemical processes, it is not surprising that a jaundiced baby is sleepy, making feeding difficult. This is why it is important to feed a little and often.
If the baby is reluctant to breastfeed, milk can be expressed and given to the baby using a spoon or cup. This avoids the baby using up too much of his energy on actually feeding. The breast can be offered for short periods, whilst the mother is encouraged to express in between times, until the baby is strong enough to take all the feeds himself. It is not necessary to give formula feeds, as long as enough expressed breast milk is collected.
Extra clear fluids used to be given to 'flush' the kidneys. However this is now known to be unnecessary. The priority is to provide the baby with sugars for energy and proteins to bind with bilirubin. These are both available in the perfect proportions in the mother's own breastmilk.
In this way, 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, alongside phototherapy should be enough to treat most infants.
If you have any worries, your midwife will be happy to advise you.
© Sharon Trotter
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