How is breast milk jaundice prevented?

Updated: Dec 07, 2017
  • Author: Prashant G Deshpande, MD; Chief Editor: Muhammad Aslam, MD  more...
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Answer

Keys to deterrence and prevention of breast milk jaundice (BMJ) include the following:

  • Poor caloric intake associated with insufficient breastfeeding contributes to the development of severe breast milk jaundice. The first step toward successful breastfeeding is to make sure that mothers nurse their infants at least 8-12 times per day for the first several days, starting from the first hour of life. The whey portion of human milk contains a feedback inhibitory peptide of lactogenesis; hence, effective emptying of the breast with each feeding results in successful lactation.

  • Infants who are nursed more than 8 times during the first 24 hours have earlier meconium passage, reduced maximum weight loss, increased breast milk intake on days 3 and 5, lower serum bilirubin levels and, thus, a significantly lower incidence of severe hyperbilirubinemia (>15 mg/dL) on day 6.

  • Gourley et al demonstrated that beta-glucuronidase inhibition with L-aspartic acid and enzymatically hydrolyzed casein in exclusively breastfed babies resulted in a reduction in the peak serum bilirubin level by 70% in first week of life. [32]

  • According to the American Academy of Pediatrics clinical practice guidelines for the management of hyperbilirubinemia in the newborn aged 35 or more weeks' gestation, exclusive breastfeeding is a major risk factor for severe hyperbilirubinemia; thus, all infants should be evaluated for the risk of subsequent hyperbilirubinemia by plotting their discharge serum bilirubin levels on an hour-specific nomogram. [29]

  • Transcutaneous bilirubinometry is a measurement of yellow color of the blanched skin and subcutaneous tissue, and it can be used as a screening tool. This tool has been shown to be fairly reliable, with good correlation between total serum bilirubin (TSB) and transcutaneous bilirubin (TcB) levels obtained using instruments available in the United States. The TcB measurement tends to underestimate the TSB at higher levels. [33]  Confirmation with TSB measurement is indicated in all patients with TcB levels above the 75th percentile and in those in whom therapeutic intervention is considered.

  • Studies have suggested that combining clinical risk factors with predischarge measurement of TSB or TcB levels improves the accuracy of risk assessment for subsequent hyperbilirubinemia. [34]  The factors most predictive included predischarge TSB or TcB levels above the 75th percentile, lower gestational age, and exclusive breastfeeding. [35]

  • Newborns who are exclusively breastfed and who have elevated predischarge TcB or TSB levels do not qualify for discharge before 48 hours and should be evaluated for phototherapy in 24 hours. Newborns with TcB and TSB levels in the high-intermediate range and newborns who were born at less than 38 weeks' gestation should undergo repeat TcB and TSB measurements within 24 hours of discharge, or they should receive follow-up within 2 days. [36]


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