Breast milk jaundice is a type of jaundice that can affect healthy newborns as a result of breastfeeding. It usually develops after the first four days or into the second week of life, and though it is unrelated to hemolytic disease of the fetus and newborn (HDFN), it can still occur in infants diagnosed with the disease or make a previous case of jaundice worse.
What is HDFN?
Hemolytic disease of the fetus and newborn (HDFN) is an immune-mediated red blood cell disorder that occurs when a baby’s RBCs break down quickly, which is called hemolysis. HDFN is caused by a mismatch between a mother’s and her baby’s blood type (A, B, AB, or O) or Rhesus (Rh) factor (Rh-positive or Rh-negative) during pregnancy.
It may last several weeks, but it is not usually a cause for concern and mostly resolves itself without treatment. Breast milk jaundice has been reported to affect 20%-30% of newborns from three to four weeks of age who are primarily being breastfed.
Learn more about HDFN causes and risk factors
What is the difference between jaundice and breast milk jaundice?
Jaundice associated with HDFN and breast milk jaundice both originate from a buildup of bilirubin in the newborn’s blood. Bilirubin is a yellow substance that is produced when red blood cells break down, which in adults occurs every 120 days.
While in adults, it is easily processed by the liver and eliminated in urine or stools, a newborn’s liver is immature and has trouble processing it. This causes the bilirubin to build up in the blood and causes symptoms.
The symptoms of jaundice and breast milk jaundice are the same, namely a yellowish tint that affects the skin, whites of the eyes and gums. However, in jaundice associated with HDFN, the baby is likely to show additional symptoms such as lethargy, irritability and feeding issues.
Jaundice that occurs in newborns with HDFN is the result of anemia and the destruction of red blood cells that have been attacked by maternal antibodies. If left untreated, bilirubin can accumulate and cross the blood brain barrier, causing long term neurological damage or even death.
The exact cause breast milk jaundice has not been defined, but it is thought to occur as a result of proteins and enzymes that inhibit the conjugation of bilirubin, which then allows for it to be excreted.
Managing breast milk jaundice
To ensure that jaundice is indeed related to breastfeeding and not another pathology, such as HDFN, the newborn’s bilirubin levels need to be measured, as well testing of hemoglobin, red blood cells and a reticulocyte count.
In breast milk jaundice, if bilirubin levels are below 20 mg/dL, no treatment is required, and advice is to continue breastfeeding. Over this level, phototherapy is recommended, which helps break down the bilirubin by making it water soluble and easier to eliminate, and breastfeeding may need to be paused.
While breast milk jaundice is generally benign, it requires close monitoring and potentially treatment.
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