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breast milk jaundice treatment - medical care :
• Treatment recommendations in this section apply only to healthy term infants with no signs of pathologic jaundice. In preterm, anemic, or ill infants and those with early (<24 h) or severe jaundice (>25 mg/dL or 430 pmol/L), different treatment protocols should be pursued .
• For healthy term infants with breast milk or breastfeeding jaundice and with bilirubin levels of 12 mg/dL (170 pmol/L) to 17 mg/dL, the following options are acceptable:
o Increase breastfeeding to 8-12 times per day and recheck the serum bilirubin level in 12 hours. This is assuming that effective breastfeeding is occurring, including milk production, effective latching on of the baby, and effective sucking with resultant letdown of milk. Breastfeeding can also be supported with manual or electric pumps and the pumped milk given as a supplement to the baby.
o Continue breastfeeding and supplement with formula.
o Temporary interruption of breastfeeding is rarely needed and is not highly recommended.
• For infants with bilirubin levels from 17-25 mg/dL (294-430 pmol/L), add phototherapy to any of the previously stated treatment options.
• The most rapid way to reduce the bilirubin level is to interrupt breastfeeding for 24 hours, feed with formula, and use phototherapy; however, in most infants, interrupting breastfeeding is not necessary or advisable.
• Phototherapy can be administered with standard phototherapy units and fiberoptic blankets. Fiberoptic phototherapy can often be administered safely at home, which may allow for improved infant-maternal bonding. In locations where phototherapy is unavailable, natural sunlight is an alternative. Caution should be exercised as the intensity of sunlight is of course not standardized and risk of sunburn exists. Phototherapy can be discontinued when serum bilirubin drops below 15 mg/dL (260 pmol/L). It has been shown that average bilirubin level rebound is less than 1 mg/dL (17 pmol/L), so rechecking the level after discontinuation of phototherapy is not necessary. For an in-depth discussion of phototherapy.
breast milk jaundice consultations:
• Consider consultation with a neonatologist when the serum bilirubin level rises above 20 mg/dL (430 pmol/L) or when signs and symptoms suggest pathological jaundice and the rate of rise in the serum bilirubin level is more than 0.5 mg/dL/h.
• Consultation with a lactation consultant is recommended in any breastfed baby who has jaundice. The expertise can be extremely helpful, especially in situations in which inadequate breastfeeding is contributing to the jaundice.
breast milk jaundice diet:
• Continue breastfeeding, if possible, and increase frequency of feeding to 8-12 times per day.
• Depending on maternal preference, breastfeeding can be supplemented or replaced by formula at the same frequency. Supplementation with dextrose solution is not recommended because it may decrease caloric intake and milk production and consequently delay the drop in serum bilirubin concentration. Breastfeeding can also be supplemented by pumped breast milk.
Activity:
• No restrictions are necessary.
• Encourage parents to remove the child from the warmer or infant crib for feeding and bonding. Fiberoptic blankets allow holding and breastfeeding without interruption in treatment.
breast milk jaundice - Further Inpatient Care:
• If the patient has not been discharged with the parent, monitoring daily weights and serum bilirubin concentration for the need for phototherapy as well as assessment of caloric intake are important. Once serum bilirubin concentration is determined to be within a safe range (<20 mg/dL) and is not rising rapidly, home phototherapy is an option to consider as long as thorough outpatient follow-up (home visiting nursing assessment or office check-up and bilirubin level monitoring) are feasible.
breast milk jaundice - Further Outpatient Care:
• If the infant is treated on an outpatient basis, measure serum bilirubin levels daily either in the clinic or in the home with home-health nurses until the bilirubin level is below 15 mg/dL (260 pmol/L).
Transfer: Transfer infants with pathologic jaundice or bilirubin levels greater than 25 mg/dL (430 pmol/L) to a center capable of performing exchange transfusions.
Complications: Kernicterus is rarely reported in breast milk jaundice.
Prognosis: Prognosis is excellent, although jaundice may persist for up to 12 weeks in breastfed infants.
Patient Education: Provide excellent breastfeeding education. Refer to a lactation consultant or La Leche League.
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