• Posted by Dr. Jay Gordon

Red blood cells break down at a somewhat higher rate in newborns and some of the breakdown products have colors. Bilirubin is yellow and often gives a yellow tinge to the babies eyes and skin. The liver is responsible for excreting these metabolic “wastes” and it’s somewhat slower to do so in the first days and weeks of life. As a result, jaundice (also called hyperbilirubinemia or just “hyperbili”) is much more visible.

In extreme situations, hyperbili can stain the brain and damage it or make babies sleepy, lethargic and prone to under eating and dehydration. Severe infections often have jaundice as their first sign. These are rare problems but it is dangerous to ignore the possibilities.

In the vast, vast majority of healthy full term babies, mild jaundice is normal and harmless. Breastfeeding babies get more jaundiced than formula fed babies and there are some researchers who think this represents an advantage because bilirubin is a “bacteriostatic” chemical. That is, it inhibits the growth of infectious bacteria.

Jaundice itself may not be a problem but increased jaundice may indicate poor breastfeeding. This is a problem and this is one of the reasons that the “knee jerk” reaction to jaundice is so dangerous. Instead of just attempting to change the baby’s color from slightly yellow (or quite yellow) we should be looking much harder at the reason for the increased bilirubin. Lactation consultation is usually much more valuable than bilirubin tests and bili lights.

PLEASE REMEMBER, this information is strictly applicable to healthy full term babies; preemies and sick kids must be cared for differently and this is beyond the scope of this brief discussion.

Jaundice may continue and even increase through the first week or two and if a baby is doing well, milk is in, nipples are not sore, jaundice is rarely a problem. If a baby continues to lose weight and jaundice is increasing, lactation help is needed and closer medical observation is crucial.

It is almost never correct to interrupt breastfeeding nor to supplement babies with mild to moderate jaundice. The disease entity called “Breast Milk Jaundice” is rare and possibly involves a chemical in breastmilk which inhibits the metabolism of bilirubin. This jaundice is longer and more yellow and almost always harmless. Some experts advocate breastfeeding interruption for a day to help make the diagnosis in a baby with jaundice beyond week two or three. Many experts do not recommend this and instead will wait if the baby’s clinical appearance is reassuring.

Jaundice is a normal condition of babies in the first week of life. Healthy full term babies who are nursing well, urinating and looking good do not need intervention. Supplementing with water makes this worse and supplementing with formula is not necessary and interferes with breastfeeding success and good health.

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