Management of Jaundice in the Breastfeeding Infant 35 Weeks or More of Gestation
Recommendations
Evidence-Based Strategies for Preventing or Ameliorating Jaundice in the Breastfeeding Infant
Initiate early breastfeeding
Encourage frequent exclusive breastfeeding
Optimize early breastfeeding management
Provide education on early feeding cues
Identify mothers and infants at risk for hyperbilirubinemia
- Close follow-up of the breastfeeding newborn both facilitates prevention of excess weight loss that may contribute to hyperbilirubinemia
Management of Breastfeeding in the Newborn with Jaundice
- Special care should be taken to address and discuss any guilt parents have about their feeding decisions, both because such guilt can be counterproductive to continued breastfeeding
- and because many factors contribute to jaundice and the relative contribution of each factor is often unknown.
Treatment options
Phototherapy
- Only in extenuating circumstances is temporary interruption of breastfeeding with replacement feeding necessary.
- Phototherapy can be done in the hospital or at home. Home phototherapy is acceptable for low-risk infants provided TSB levels are monitored.
- In the hospital, it is best done in the mother’s room or a hospital room where the mother can also reside to minimize mother–infant separation and so that breastfeeding can be continued. Interruption of phototherapy for durations of up to 30 minutes or longer to permit breastfeeding without eye patches does not alter the effectiveness of the treatment.
- Although phototherapy increases insensible water loss to some degree, infants under phototherapy do not routinely require extra oral or intravenous fluids.
- First and best supplement is expressed own mother’s milk. It can be hand expressed into a small cup or spoon and directly fed to the infant with help from staff who are knowledgeable in this technique. In this way, breastfeeding is best supported.
- If own mother’s milk is not available, supplementing with donor human milk will increase enteral intake. Breastfeeding infants supplemented only with donor milk meet the World Health Organization definition of exclusive breastfeeding. The specific effect of donor milk supplementation on bilirubin levels has not been studied.
- It may be necessary to supplement with infant formula if neither own mothers’ milk nor donor human milk is available. The impact of introducing formula to an exclusively breastfed infant must be considered. The effect of supplementation with donor human milk versus infant formula is not well studied.
- Supplementation of breastfeeding should preferably be undertaken using a cup, spoon, syringe, or supplemental nursing system (if infant is latching) simultaneously with or immediately following each breastfeed. Nipples/teats and bottles should be avoided where possible. However, there is no evidence that any of these methods are unsafe or that one is necessarily better than the other.
- Supplementation of breastfeeding with infant formula. As infant formula inhibits the intestinal reabsorption of bilirubin, it may sometimes be used to lower TSB in breastfeeding infants.
- Small-volume (10–15 mL) feedings of formula immediately following a breastfeeding may be preferred to intermittent large-volume (30–60 mL) supplementation so as to maintain frequent breastfeeding and preserve maternal milk production at a high level.
Temporary interruption of breastfeeding
Post-treatment follow-up and evaluation
Encouragement to continue breastfeeding is of the greatest importance since many parents will be fearful that continued breastfeeding may result in more jaundice or other problems. Parents can be reassured that almost all hyperbilirubinemia requiring treatment resolves within the first 5 days after birth. Even those infants with more prolonged breast milk jaundice who required and received treatment rarely have sufficient rise in bilirubin with continued breastfeeding to require further intervention. ()
Recommendation Grading
Overview
Title
Management of Jaundice in the Breastfeeding Infant 35 Weeks or More of Gestation
Authoring Organization
Academy of Breastfeeding Medicine
Publication Month/Year
September 14, 2017
Last Updated Month/Year
June 9, 2022
Supplemental Implementation Tools
Document Type
Guideline
External Publication Status
Published
Country of Publication
US
Document Objectives
Provide guidance in determining whether and how breastfeeding may or may not be contributing to infant jaundice. To review evidence-based strategies for ameliorating jaundice in the breastfeeding infant. To provide protocols for supporting breastfeeding while infants are being evaluated and/or treated for jaundice
Inclusion Criteria
Female, Male, Adult, Infant
Health Care Settings
Ambulatory, Emergency care, Home health, Hospital, Outpatient
Intended Users
Nurse midwife, dietician nutritionist, nurse, nurse practitioner, physician, physician assistant
Scope
Counseling, Management, Treatment
Diseases/Conditions (MeSH)
D001942 - Breast Feeding, D064186 - Prenatal Education, D051556 - Hyperbilirubinemia, Neonatal, D007232 - Infant, Newborn, Diseases
Keywords
postpartum, Breastfeeding, jaundice, infant jaundice, Hyperbilirubinemia