Early Onset Breast Feeding Jaundice
(breast feeding jaundice) “suboptimal intake hyperbilirubinemia.” i.e. decreased feeding - (due causes?)
Causes
- Breastfeeding exaggerates physiologic jaundice in the first postnatal week because of caloric deprivation, leading to an increased in enterohepatic circulation.
- Mild dehydration and delayed passage of meconium also play roles.
Prevention
- Successful breastfeeding decreases the risk of hyperbilirubinemia.
- Infants need to be fed at least 8–12 times in the first few days after birth.
- The best way to judge successful breastfeeding is to monitor infant weight, urine output, and stool output.
- Newborns should have six wet diapers and three to four yellow, seedy stools per day by the fourth day after birth. 6W-3S per day
- Breastfed infants should lose no more than 10 % of their body weight by the third or fourth postnatal day.
Late Onset Human Milk Jaundice
“breast milk jaundice syndrome.”
- Usually occurs from the 6th through the 14th day after birth and may persist for 1–3 months.
- It is suggested that beta-glucuronidases and non-esterified fatty acids in the human milk inhibit enzymes that conjugate bilirubin in the liver.
Management
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Treatment for breast milk jaundice is not necessary unless the infant’s total serum bilirubin level exceeds the phototherapy guidelines.
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The first step of management is phototherapy.
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If the total serum bilirubin level remains below 12 mg/dL, the recommendation is to continue breastfeeding.
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If the total serum bilirubin level is higher than 12 mg/dL but below the phototherapy level, and further investigation shows no hemolysis evidence, the recommendations are also to continue breastfeeding.
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When the bilirubin is greater than 20, a brief 24-hour cessation of breastfeeding may be beneficial.