The Term Infant with Problems: Treatment of Early Jaundice

Therapies

Phototherapy is the main method used for decreasing elevated bilirubin levels in newborns. Phototherapy causes the breakdown of bilirubin in the skin. Once the bilirubin is broken down, it is easier to excrete. The use of phototherapy should be based on a combination of the total bilirubin level, the age in hours of the infant, gestational age of the infant, and other risk factors for development of jaundice. A graph with the guidelines for the use of phototherapy in newborns > 35 weeks gestation who are still in the hospital is available on page 304 of Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation ( AAP Jaundice, 2004 ).

Breastfed infants with bilirubin levels < 20 mg/dL need to be encouraged to feed frequently and should have their weight monitored. If their weight is beginning to increase then the mother's milk supply is good and the bilirubin should start to decrease.

The effects of other therapies on early jaundice in breastfed infants

There is no data to show that stopping breastfeeding and switching to formula will decrease the bilirubin level faster than continued breastfeeding. Stopping breastfeeding may delay the mother's breast milk in "coming in" so this should not be recommended. Also, mothers may think that there is something the matter with their breastmilk and may not restart breastfeeding. ( James, 1993 , Auerbach, 1992 , Kemper, 1989 , Martinez, 1993 ).

If the mother's milk supply is low, there are difficulties with nursing, or if the baby is continuing to lose weight, supplemental formula may be indicated. This should be done in a method that is compatible with continuing breastfeeding (See Supplementation Techniques).

DeCarvalho showed that giving supplemental water to babies either as treatment for jaundice or to prevent jaundice had no effect ( DeCarvalho, 1981 ).

Other investigators found that giving glucose water to breastfed infants was associated with increased bilirubin levels and decreased breast milk intake. The infants may have been filling up on glucose water, and nursing less effectively, which delayed the increase in their mother's milk supply. Jaundiced infants do not need extra water or glucose water ( Nicoll, 1982 ).

If supplementation is needed for a medical reason in a jaundiced baby formula should be given in a method that is consistent with maintaining breastfeeding (See Supplementation Techniques).