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Thursday, March 6, 2014
Newborn and Infant Care
Slight jaundice one month old
my son, full term, wt 7 lbs 15 oz, is now one month old and has been exclusively breastfed. At 26 hrs old at discharge his bilirubin was 6.1 and at 5 days old he was showing signs of jaundice the level was 12. He is fed on demand, usually every 2 hours, has numerous stools and has always been a great nurser. The question is, his eyes still have a slight yellow color in the outside corners, but the rest of his body seems normal. His level is now 9. Should I be concerned? What is the normal level for a one month old?
Congratulations on your healthy new baby and the choice to breastfeed him! That's such a great gift to him in terms of protection from disease as well as nutrition.
There are 4 different types of jaundice and they each turn up at particular times after birth. Pathologic jaundice is usually do a difference in blood type between mother and baby and appears within 24-48 hours of life. The most common jaundice is called physiologic jaundice and peaks between 3 and 5 days of age. That would be when your son had a bilirubin of 12. Another type is breastfeeding jaundice where a breastfed baby does not get enough breast milk volume and therefore does not stool often enough to rid the baby's body of processed bilirubin. This peaks around 7-10 days. The last type, breast milk jaundice occurs only in breastfed babies and lingers around, sometimes for months. The current thinking is that it represents a different processing of breast milk and bilirubin in some babies. Unlike high levels of physiologic jaundice (a bilirubin of 15 or more in a 3 day old), breast milk jaundice has never been shown to be harmful to babies. Also, each of these types of jaundice can overlap with one another.
The usual bilirubin level for a 30-day-old baby is 1.0-2.0. So 9.0 is definitely higher. Some doctors recommend that the mother stop nursing for one day and give the baby formula, while continuing to pump breast milk to maintain the milk supply. then resume nursing after 24 hours. The bilirubin level will go up but not as high as it was before. Since your son's bilirubin level is well below 15, likely his doctor is not concerned. There is no one correct way to handle breast milk jaundice. His doctor is being careful to obtain bilirubin levels, which is the standard of practice. I would encourage you to discuss this with your son's doctor to make sure you have all of the information you want and need to feel comfortable.
Mary M Gottesman, PhD, RN, CPNP, FAAN
Professor of Clinical Nursing
College of Nursing
The Ohio State University