Jaundice refers to the yellow coloring of the infant's skin that is associated with elevated bilirubin levels in the blood. All babies have slight elevations in bilirubin after birth. This is related to the normal breakdown of extra red blood cells that occurs as the infant adjusts to life outside the womb. High levels of bilirubin are a concern because it can lead to brain damage, but there have been no reports of a baby with breastmilk jaundice developing this dangerous complication. Preemies, more vulnerable to brain damage from high bilirubin, rarely develop serious complications. (Mohrbacher, N. & J. Stock, 1997)

True breastmilk jaundice, also referred to as late onset jaundice, is relatively rare, in the range of 0.5 to 4 percent of births. (Riordan & Auerbach 1999) (Lawrence 1994)

Breastmilk jaundice is defined as serum bilirubin greater than 10 mg/dl in the third week of life, when other organic and functional causes have been ruled out. It is sometimes diagnosed by feeding the baby other milk in addition to, or in place of, breastfeeding to see if the bilirubin level drops. This method of diagnosis is controversial and may not be necessary. (Riordan & Auerbach 1999) Dr. Jack Newman feels that an interruption of breastfeeding to diagnose breastmilk jaundice is "completely unjustified." (Newman & Pitman 2000)

Physiologic or normal jaundice occurs in about one-half of all newborns. Physiologic jaundice causes a peak in bilirubin levels at about three to five days of age. It can be caused by, or aggravated by, an inadequate intake of breastmilk, which is why it is sometimes confused with breastmilk jaundice. A better name for it may be "lack of breastmilk jaundice."

Once reasons for the infant's inadequate intake of breastmilk are corrected, physiologic jaundice is often easily resolved with improved nutrition and other interventions that do not interrupt breastfeeding. Because this type of jaundice is often associated with a less than adequate intake of milk, it is not possible to diagnose breastmilk jaundice until it is established that the baby is feeding well. (Newman & Pitman 2000)

Breastmilk jaundice usually peaks at seven to ten days. This often follows the earlier elevated bilirubin levels associated with physiologic jaundice. According to Dr Lawrence, it is only necessary to discontinue breastfeeding if the bilirubin level rises above 16 mg/dl for more than 24 hours.

According to research as many as 36 percent of babies may have some elevation in bilirubin levels into the third week, yet these babies suffer no ill effects. Some are theorizing that elevated bilirubin may be normal or even have a protective factor that is not yet understood. Typically babies with late onset jaundice are thriving and no interruptions of breastfeeding are necessary in most cases. (Riordan & Auerbach 1999) (Lawrence 1994) (Newman & Pitman 2000)

It is true that breastmilk jaundice tends to repeat in siblings. It is also more common in non-Caucasians. Be sure to discuss your concern with your pediatrician before your baby is born.. Ask how they usually treat jaundice in the breastfed baby and express your desire to avoid formula if at all possible because of the associated risks. You are off to a wonderful start by addressing your concerns and becoming informed early.

References:

• Breastfeeding: A Guide for the Medical Professional, Lawrence, R. ,Mosby, New York, 1994, 152-4.
• The Breastfeeding Answer Book, Mohrbacher, N. & J. Stock, La Leche League International, Schaumburg, Illinois 226-7, 1997.
• Dr. Jack Newman's Guide to Breastfeeding, Newman, J. and T. Pitman, HarperCollins, 130-35, 2000.
• Breastfeeding and Human Lactation, Riordan, J. & K. Auerbach, Jones and Bartlett, Boston, 382-89, 1999.