Jaundice in newborns is the most common symptom observed during the first hours and days of life. Early jaundice, is associated with elevated levels of bilirubin in the blood - the highest during life. Late jaundice is associated with a component in breast milk that affects the reuptake of bilirubin in the intestines, leading to elevated levels in the blood. This condition usually persists for up to 10 days after birth and passes as lactation normalises. If the symptoms of jaundice persist for more than 14 days, further diagnosis is necessary.
Food supply
When mother's milk does not meet the daily amount of calories necessary for the child's proper development, it is said that there is an inadequate food supply in exclusively breastfed babies, which is not uncommon. According to clinical practice, in about 10 % to 18 % of exclusively breastfed infants, birth weight decreased by about 10 % and this is what was associated with increased blood bilirubin levels. The baby's behaviour is also not unaffected, showing reduced activity, sucking less vigorously during feeding. Furthermore, this can have further consequences as, in a situation of increasing caloric deprivation, intestinal peristalsis can be slowed down and meconium retention can occur, which has a significant effect on increasing the intestinal-hepatic circulation of bilirubin. It is worth noting that differences in bilirubin levels in the blood of infants who were exclusively breastfed but optimally fed and those who were artificially fed were not observed. What is more, the artificial mixtures have properties that make it easier to bind bilirubin, thus making its reabsorption in the intestines more difficult and easier for the body to excrete it. Traditional methods of controlling jaundice symptoms include the use of supplementary feeding with water or sugar water, which is widespread among parents and accepted by some neonatal units, but which does not have the desired effect and the baby's weight falls. In addition, this type of action increases intestinal-hepatic circulation and bilirubin absorption. The jaundice of breastfed babies usually disappears when the mother's milk is normalised. This is usually observed within 10 days of delivery. If, on the other hand, symptoms persist for more than 14 days, it is necessary to deepen the diagnosis, which should be started with an in-depth history of the pregnancy, the perinatal period, any trauma and any medication taken. The way the child is fed and parameters such as the colour of the child's urine and stool are also important. The family context is also important, namely the family history as well as the occurrence of jaundice in previous children. Once the history has been taken, laboratory tests from the child's blood are necessary.
Recommendations
According to the recommendations of the American Academy of Pediatrics, the diagnostic procedure should be based on a diagnostic trial consisting of weaning off natural feeding for 24 hours, with baseline and final determination of the child's blood bilirubin level. Nevertheless, this recommendation is met with many voices against it, referring to its low specificity and to the difficulty of maintaining normal lactation. In addition, artificial feeding is incorporated into the weaning period, which always carries the possibility of allergisation. It also carries an increased risk of developing diabetes or obesity in later life.
The need for constant monitoring
It is very important that a newborn baby with prolonged jaundice is kept under constant control with regard to the level of bilirubin in the blood. This would mean frequent interventions (punctures) to take a sample for testing, which is made possible by specialised equipment such as a bilirubinometer, which measures bilirubin levels in the blood transcutaneously. However, this type of equipment is not without its drawbacks: it loses its reliability when the bilirubin level in the blood exceeds 12mg/dl, which is rare in jaundice. It is then necessary to take blood for laboratory testing.
Parent education
If the diagnosis is made and it is jaundice associated with breastfeeding, it is essential that adequate information flows to parents. It is important to support them and give them full, comprehensive information about what they are facing. Above all, it is important to explain what the benefits will be for the baby of maintaining breastfeeding, although parents knowing the cause of jaundice may be reluctant to continue breastfeeding naturally. If the condition of the newborn is good and the baby is developing normally and gaining weight gradually, only regular checks are recommended. [1]
