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What Is Breast Milk Jaundice?

Breast milk jaundice is a type of jaundice that occurs in babies when breastfeeding. It's a common condition in infants and can persist for more than three weeks after a baby is born and breastfeeding. It can resolve by itself without having to discontinue breastfeeding and can go on for eight to 12 weeks before resolving. Roughly 60% to 80% of all newborns can have some degree of jaundice.

Jaundice is when there is too much bilirubin in the blood. When this happens in a baby their eyes and skin develop a yellow coloring. Bilirubin is a yellow substance that is produced after the liver breaks down red blood cells. This is a normal process. However, jaundice occurs when the liver is not breaking down bilirubin fast enough.

Normally the processed bilirubin would be transported to the intestines and removed through the stool. In jaundice, the excess bilirubin is reabsorbed into the baby's blood. It is then deposited into different body parts including mucus membranes, the skin, and muscles.

Breastfeeding a child with jaundice. Breastfeeding provides calories and hydration for the infant while improving the mother's milk supply. Hydration reduces the levels of bilirubin in the baby's body. This means that it might be beneficial for a baby with jaundice. In some cases, breastfeeding may be interrupted for 12 to 48 hours to allow diagnosis of breast milk jaundice.

Many preterm newborns will have elevated bilirubin levels in the first weeks after birth. This is because:

  • Their red blood cells have a short lifespan
  • Newborns sometimes have delayed passage of meconium (first poop), thus, bilirubin is reabsorbed in the intestines
  • A newborn baby's liver is not yet fully developed to metabolize bilirubin fast
  • Most newborns will have physiologic jaundice which is considered harmless.

    Currently, the exact cause of breast milk jaundice is unknown. However, it is believed that it may be caused by a substance in breastmilk that prevents the liver from breaking down bilirubin. This type of jaundice is genetic. 

    Your baby might be more likely to get jaundice if:

  • They are born premature — the livers of babies born prematurely are not yet fully developed to get rid of bilirubin.
  • They are not getting enough breast milk — this may happen during the first days of life when the baby has trouble breastfeeding.
  • They are breastfeeding — breast milk may prevent the liver from getting rid of bilirubin fast enough.
  • The baby has a different blood type from the mother — this causes the mother's body to produce antibodies that attack the baby's red blood cells.
  • The baby is born with a lot of red blood cells — the more red blood cells present, the more bilirubin.
  • They have a genetic problem making their red blood cells fragile — fragile red blood cells mean that more of them will die quickly, thus, more bilirubin levels.
  • The most obvious sign of jaundice is a yellow coloration of the skin and eyes. The yellow color will start to appear on the face followed by the chest, stomach, and then the legs. Other symptoms that may show if bilirubin levels continue to rise include sleepiness and troubled feeding. Your baby may also start acting fussy or sloppy as the situation gets worse.

    It can be hard to spot the yellow coloration on your child's skin especially if they have dark skin. If you find yourself in this situation, apply some pressure on your baby's forehead or nose using your finger. If your baby has jaundice you will see the yellow color on their skin when you lift your finger.

    Sometimes things may look more serious and you might have to call your doctor. These times include:

  • When your baby is not feeding well
  • When they start looking or acting sick
  • If the baby is acting sleepier than usual
  • When you notice the jaundice is getting worse
  • Diagnosis. The doctor makes a diagnosis of jaundice after examining your baby for yellow coloration of the skin and eyes. They may also do a blood test to check the bilirubin levels in the blood. A light machine may also be used to measure bilirubin in the skin.

    Treatment of breast milk jaundice. As mentioned earlier, breast milk jaundice will go away by itself. This means that you do not have to seek treatment unless your child's bilirubin levels get too high. Treatment should occur if the bilirubin levels go higher than what the American Academy of Pediatrics (AAP) phototherapy guidelines recommend.

    Treatment of breast milk jaundice also depends on:

  • Your baby's age
  • If the baby was born early
  • The rate at which bilirubin levels are rising
  • How your baby is feeding
  • Your baby's jaundice may be treated using:

  • Phototherapy: This involves putting the baby under a light that helps the bilirubin leave the body.
  • Fluids: Hydration helps reduce bilirubin levels.
  • Immunoglobulin: This is given by injection into the vein for babies who have blood type incompatibilities and can reduce the need for exchange transfusion.
  • Exchange blood transfusion: This involves replacing the baby's blood with a transfusion when their bilirubin levels become too high.
  • There is not much to worry about if your newborn baby gets jaundice. The condition is easily treatable with proper management and monitoring. It is important to understand the best way to breastfeed as it can help your baby recover from jaundice.


    What Causes High Bilirubin?

    High bilirubin levels in newborns may be natural and temporary. However, high bilirubin in adults could be a sign of an underlying health condition, such as jaundice, gallstones, and liver issues.

    Bilirubin is a yellowish substance in your blood. It forms after red blood cells break down and travel through your liver, gallbladder, and digestive tract before excretion.

    The condition of having high bilirubin levels is called hyperbilirubinemia. It's usually a sign of an underlying condition, so following up with a doctor is essential if test results show you have high bilirubin.

    It's also a common temporary condition in newborns.

    Read on to learn more about the symptoms of high bilirubin and what can cause it.

    Typically, adult bilirubin levels fall between 0.2 and 1.2 milligrams per deciliter (mg/dL). Anything above 1.2 mg/dL is usually considered elevated.

    For children ages 15 days to 18 years, healthy bilirubin levels should be less than 1.0 mg/dL.

    Understanding what constitutes an elevated value for newborns depends on what condition the doctor is treating. Doctors will usually worry if bilirubin rises a certain amount in 24 hours.

    For example, a level of 8 mg/dl may not seem too concerning on day 2 of life, but if the day 1 value was 2 mg/dl, that 6 mg/dl rise can indicate a need for closer monitoring and treatment.

    Having high bilirubin can be a sign of several conditions. Your doctor will take your symptoms, as well as any other test results, into account to help narrow down a diagnosis.

  • Gallstones: These develop when substances like cholesterol or bilirubin harden in your gallbladder. Your gallbladder stores bile, a digestive fluid that helps break down fats before they enter your intestines.
  • Gilbert's syndrome: This is a genetic liver condition that causes your liver not to process bilirubin properly. This causes the bilirubin to build up in your bloodstream.
  • Liver dysfunction: This can be any condition that affects the function of your liver and causes bilirubin to build up in your blood. This is a result of your liver losing its ability to remove and process bilirubin from your bloodstream. Examples include cirrhosis, liver cancer, or autoimmune hepatitis.
  • Hepatitis: This happens when your liver becomes inflamed, often due to a viral infection. When it's inflamed, your liver can't easily process bilirubin, leading to a buildup of it in your blood.
  • Bile duct obstruction: Bile ducts connect your liver to your gallbladder and the opening of your small intestine, called the duodenum. They help to move bile, which contains bilirubin, from your liver and gallbladder into your intestines. Bile can't be drained adequately if these ducts become inflamed or blocked. This can lead to an increased level of bilirubin.
  • Intrahepatic cholestasis of pregnancy: This is a temporary condition during the last trimester of pregnancy. It causes bile drainage from your liver to either slow down or stop entirely. This makes it harder for your liver to process bilirubin from your blood, leading to high bilirubin levels.
  • Hemolytic anemia: This happens when blood cells break down too quickly in your bloodstream. It's sometimes passed down genetically, but autoimmune conditions, an enlarged spleen, or an infection can also cause it.
  • Bilirubin levels in newborns

    Many babies have high bilirubin a few days after birth, causing newborn jaundice. This temporary condition usually resolves on its own within a few weeks.

    It happens because newborns have more red blood cells and break them down more quickly, but their livers are not developed enough to keep up.

    Before being born, the pregnant person's liver helps with this task. A newborn's liver is only about 1% as active as an adult's.

    In most cases, higher bilirubin levels will lead to jaundice between 1 and 3 days after birth. Bilirubin levels can peak as high as 18 mg/dL on the fourth or fifth day, and jaundice typically clears up within 2 weeks as the liver matures.

    Feeding 8 to 12 times per day helps to promote regular bowel movements, which help to remove bilirubin from the body.

    If jaundice occurs within the first 24 hours after birth, or if bilirubin levels are especially high or don't begin to fall on their own, doctors may intervene with treatments such as:

    If you have high bilirubin, your symptoms will depend on the underlying cause. You can have mildly high bilirubin and have no symptoms at all.

    With moderately high bilirubin, you may only have jaundice, which is a yellowish color in your eyes and skin. Jaundice is the main sign of high bilirubin levels.

    Other general signs of illnesses that cause high bilirubin can include:

    Bilirubin levels are usually tested by taking a blood sample. A doctor will usually order this to check your liver function if you or your newborn are experiencing symptoms of high bilirubin or jaundice.

    In newborns, blood is typically taken from the heel. In some cases, doctors might use blood from the umbilical cord.

    For adults, blood is usually taken from one arm. You may need to fast before your blood test.

    Two types of bilirubin will be measured: conjugated bilirubin and unconjugated bilirubin. The ratio between these two types of bilirubin will help narrow down the underlying cause of high bilirubin levels.

    Sometimes, a urine sample will be used to test bilirubin levels. No bilirubin shouldn't be present in urine, so any bilirubin found in a urine sample indicates an underlying condition.

    Should I be worried about high bilirubin levels?

    In many cases, high bilirubin isn't a sign of anything that needs immediate treatment.

    But if you notice any of the following symptoms, call a doctor or head to urgent care just in case:

  • intense abdominal pain or tenderness
  • drowsiness or disorientation
  • black or bloody stools
  • vomiting blood
  • a fever of 101°F (38.3°C) or higher
  • easy bruising or bleeding
  • red or purple skin rash
  • What does it mean when your bilirubin levels are high?

    High bilirubin levels often mean that your liver isn't filtering bilirubin the way it's supposed to. There are many causes for this in adults. In newborns, the cause is usually newborn jaundice.

    Does high bilirubin always mean liver damage?

    High bilirubin levels may mean a problem with your liver, but not necessarily. There are causes unrelated to the liver that can raise your bilirubin levels, such as hemolytic anemia.

    High bilirubin levels usually indicate that something is not working as expected in your liver or gallbladder. Some of these conditions aren't too serious, but monitoring and treating them is essential.

    Anyone with jaundice, the main sign of high bilirubin levels, should contact their doctor. If your doctor isn't immediately sure what's causing your high bilirubin levels, you may need to return for additional blood, liver function, or other tests.


    Medications And Their Potential To Cause Increase In 'Jaundice' (Icterus)

    List of Drugs that may cause 'Jaundice'

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    Updated on August 25, 2023 This page features an assortment of drug(s) that could potentially trigger 'Jaundice' as a Side-effect or adverse response. It is not uncommon for medications to have some tolerable mild side effects. Do remember that these listed medication(s) only represents individual medications that could be part of a larger combination therapy. Please keep in mind that this list of drug(s) is intended to serve as an information resource and should not be a substitute to professional medical advice. If you have concerns about 'Jaundice', we advise that you speak with a healthcare professional. Similar to 'Jaundice,' there are other symptoms or signs that might more accurately describe your side effect. They are detailed below for your convenience. If any of these additional symptom(s) align more closely with your experience, you can choose them to determine potential medications that could be responsible.

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    Chlorpromazine

    Most other Common Side Effects: involuntary muscle movements, reduced white blood cell counts, low blood pressure and drowsiness

    Fusidic acid

    Most other Common Side Effects: liver dysfunction, gastrointestinal disturbances and death of tissues

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    Sodium Fusidate

    Most other Common Side Effects:

    Find drugs that can cause other symptoms like 'Jaundice' References
  • https://www.Fda.Gov/drugs/information-consumers-and-patients-drugs/finding-and-learning-about-side-effects-adverse-reactions
  • https://nctr-crs.Fda.Gov/fdalabel/ui/search
  • https://dailymed.Nlm.Nih.Gov/dailymed/
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