BreastMILK Jaundice

Not to be confused with it's common friend breastFED jaundice, breastmilk jaundice is pretty rare and was a source of great frustration during Ben's first 4 months of life.  As a PNP I had heard of breastmilk jaundice, but in truth because this is a diagnosis confirmed by a pediatric GI specialist, as a primary care PNP I had not encountered it in practice.  So when my baby boy started glowing orange (like serious glow worm status) just days after he was born I expected the "normal" round of tests and treatments for a jaundice baby.  He had blood work taken and my colleagues/his doctor reviewed the hospital lab work for both Ben and myself.  We ended up back in the hospital for about 24 hours while Ben screamed his innocent little head off under the UV lights, which brought his glow down to a just-back-from-vacation-at-the-beach status.  But, our follow up the next morning revealed that his levels were quickly climbing back up, which shouldn't happen.  It was very likely at this point that he had breastfeeding jaundice.

Breastfeeding jaundice is a fairly common occurrence, and as a primary care provider we don't panic too much with this one and simply monitor the situation through frequent assessments and lab work.  Typically until levels are declining and a good eating pattern has been established for the baby.  In most cases there is no need to substitute breastmilk with formula as long as the baby is eating more than 8 times a day and dirtying diapers well.  However, in some persistent cases, or levels that continue to creep higher, providing formula for 48-72 hours (pump and save that breastmilk!) will quickly help bilirubin cycle out of the body, and this method can be diagnostic to confirm that breastfeeding was the source of the issue.  In either case, after a few weeks of life the issue should have resolved and levels shouldn't rise significantly once breastfeeding is resumed.

Back to our personal journey....  Beyond the frequent check ups and blood draws, we were referred to a GI specialist (Ben's levels just hovered at a high level that warranted a double check by the liver pros), and we were given the instructions to give only formula for 72 hours.  Sure enough, Ben's levels dropped back down some immediately following that diet change - yay!  And unfortunately, as soon as breastfeeding resumed he jumped right back up to those almost dangerous levels - ugh (even thinking about this now makes me sigh audibly).

This is AFTER treatment at 4 weeks old...his color actually looks quite good here

Everyone's suspicion now pointed at breastmilk jaundice.  While breastfeeding jaundice can be resolved by increased consumption and stooling, breastmilk jaundice actually gets worse because these babies have an increased biliruibin reabsorption from the gut.  There is something in the breastmilk itself - interestingly while numerous theories exist regarding exactly what this is, there is no conclusive answer to the mystery "ingredient" - that keeps the elevated bilirubin circulating in the blood.  The more milk that is consumed, the more stable those levels are.  The good news is that there are virtually zero cases of these elevated levels harming the baby and there is no reason to discontinue breastfeeding.  For us, Ben remained jaundice (or as we like to say, tanned) for 4 months.  We had frequent blood draws and we did have his liver examined with imaging to rule out any other abnormalities, and those moments were hard for us.

Today, at 16 months old he still nurses 3 times a day.  There have actually been a few times here and there where I thought he looked a tinge orange, but his GI doc assured me that while this is possible for the duration of my time nursing him, there is no reason to check his levels unless it is a drastic or prolonged change.  I was so thankful for the supportive team of doctors and nurses we worked with while figuring out the answer to Ben's colorful start.  I suspect many moms quit breastfeeding when a diagnosis of breastmilk jaundice comes about, because frankly it is frightening to hear that your milk is causing something to go wrong within your baby.  But breastmilk continues to be the best nutrition possible (should you be able and interested in providing it!) and I know Ben and I have both benefited from continuing our breastfeeding journey despite this struggle.