Breastfeeding and human milk: their association with jaundice in the neonate.

As demonstrated by this discussion, jaundice in breastfeeding infants appears to be related both to feeding-related issues and to an as-yet unidentified factor in the human milk of a small minority of women. In the case of feeding-related factors, how a mother breastfeeds; that is, how often she offers the breast and how well the baby suckles, as well as how often and how much the baby is offered complementary or supplementary feedings of water, glucose solutions, or a nonhuman mammal milk, influence serum bilirubin concentrations in the first week of postnatal life. We call this breastfeeding-related jaundice, recognizing that the feeding process is a key element in the condition. We urge that management recommendations focus on the feeding process to reduce the level of serum bilirubin concentration in the first week of life. It is appropriate to note at this juncture that hyperbilirubinemia also occurs in bottlefed infants; the frequency of feeding of these infants also may play a role in the severity of jaundice. If research findings bear out such a relationship, we may see a corollary label of "feeding-related" jaundice also applied to bottlefed babies. In a very small percentage of breastfeeding infants, a second form of jaundice occurs. Its onset appears somewhat later in the postnatal period, and it is characterized by a higher peak and a slower decline in the level of serum bilirubin concentration. We call this breast milk jaundice, recognizing that it appears to stem from the milk the baby receives rather than the manner in which he or she is fed. Eliminating other causes of jaundice prior to considering even a brief interruption of breastfeeding is appropriate when caring for the infant with this syndrome. In the breastfeeding infant, both early- and late-onset jaundice appear to be related. We suggest this because the baby with breast-feeding jaundice may be more responsive to the factor in abnormal milk, which produces breast milk jaundice. The infant with breast-feeding jaundice has a larger bilirubin load at the time the abnormal milk is being ingested. The recycling of this increased load, because of exaggerated enterohepatic circulation, results in a further late rise in serum bilirubin. If the initial bilirubin pool is smaller, the effect of the abnormal milk might well be insignificant or at least markedly diminished.(ABSTRACT TRUNCATED AT 400 WORDS)