Jaundice 101

Every newborn has elevated levels of bilirubin in the first 24hrs of life.  Here's how to prevent it from becoming the most common type of jaundice.
Newborns in the first few days of life have too many red blood cells in order to ensure that they get enough oxygen. They have just begun to learn to breathe, so nature wants to make sure they get enough.

These extra red blood cells begin to die and are broken down in the liver.  The natural byproduct of this process is the antioxidant bilirubin.  Everyone has bilirubin--it's what stains our poop brown--and everyone gets rid of it.  Everyone, including newborns, needs protein and mastication (chewing) to move the bilirubin out through his or her poop.  Chewing is actually what makes your bowels move, not the fact that you are taking in more food.  Babies don't chew, they suck, but the mouth motion will do the same thing.

If the bilirubin can't get out through the poop, and keep accumulating, then it tries to get out through the skin, staining it yellow.  Babies with jaundice are put under UV lights to help break down the bilirubin in the skin to allow it to get out of the body.  In untreated cases, bilirubin will go to the brain and can cause brain damage.  This is a major reason to go to the 2-day and 2-week well baby check-ups.  The Pediatrician will make sure your baby is healthy.

Of course, it would be best if we could get the bilirubin out through the poop and didn't allow it to get to the skin.  This means all babies need to get protein and need to suck.  Solution: Breastfeeding!

In the first few days of breastfeeding, mothers have a low volume of highly concentrated milk.  The baby must suck alot to get a little bit out.  The sucking makes their bowels move--getting rid of the meconium (first poop) and bilirubin.  A newborn in the first few days should breastfeed every 2 hours for about 30-40 minutes, or until he or she self-detaches from the breast.  That's alot of sucking!

Note: Don't time feedings.  Let the baby decide how often and how long.  The 2 hour rule is to give you an idea of how much the baby should need.  Many babies don't make the full 2 hours and will want to breastfeed sooner.  Let them breastfeed for as long and as often as they want.

The current recommendations for breastfeeding are: 8 or more times per day.  This was based on a study from Japan.  It turns out that 8 times is really the absolute minimum, and more than 8 is ideal.

Researchers Yamauchi and Yamanouchi from the Children's Medical Center in Okayama National Hospital in Japan conducted a study in 1990.

The study found that, on the 6th day of life:
newborns nursed 4 or fewer times in the first 24 hours had a 28% increased bilirubin
newborns nursed 7 to 8 times  in the first 24 hours had 12% increased bilirubin
newborns nursed 9 or more times in the first 24 hours did not have elevated bilirubin levels at all

Translation: Feeding a newborn 9 or more times in the first 24 hours may prevent the development of jaundice.

Problems with breastfeeding can arise.  This is how some jaundice cases get labeled "Breastfeeding Jaundice".  Really, it's "I'm-having-trouble-breastfeeding Jaundice".  Breastfeeding doesn't cause jaundice. When it goes well, it actually prevents jaundice.

Newborns are also just learning to eat and their mothers are just learning to feed them.  Some newborns have trouble latching on well, which can compromise their feeding.  If this happens, it's ok.  Just keep trying and ask for help.  If a baby's skin gets a little yellow, it's not a problem as long as it's treated.  Treatment of UV lights works well, but it may require mother-baby separation for a short time.  Ask if the light box can be brought to your room.

In cases where the baby isn't breastfeeding well at all, the doctor may want to supplement the baby with formula for 12 hours to ensure that he or she gets enough protein.  If this happens, ask for the Board Certified Lactation Consultant on staff to help you supplement at breast, not using a bottle.  There is a device that has a small tube that slips into the baby's mouth along-side the nipple to dispense formula or pumped milk.  Supplementation at breast is the best way to preserve breastfeeding when a baby needs supplemental food, and it will prevent further breastfeeding problems.

If supplementation at breast isn't possible, then a bottle AND a pacifier are necessary.  The baby will quickly suck all of the formula out of the bottle, but will still need to suck more to get the bowels moving.  In this case, it will be necessary to use a pacifier.  This is not the ideal situation for a mother who wants to breastfeed, but with good support around her and alot of patience, the mother can continue breastfeeding just fine.

The best way to deal with jaundice is to prevent it in the first place.  Take a breastfeeding class while pregnant to teach yourself basic techniques before you have to do it.  Also, ask for help, and if you don't like the person sent to your room, ask for a different person.  Be sure to ask for a Board Certified Lactation Consultant, as well.  Be proactive.  If you have trouble being assertive about it, have your husband or mother or whoever is there with you be assertive for you.  Breastfeeding is worth it, even if it seems too overwhelming at first.

There are other causes of jaundice as well, but this is the most common one.