Jaundice- Bilirubin- What is Going On?

Lately we have had a flux of clients whose babies were subjected to bili lights- bil beds and separation from their moms and/or their moms staying an extra day in the hospital due to elevated bilirubin levels. It is really amazing that these babies levels are really what I thought were considered low. Weird that I left the hospital on day two with a baby at the level of 18 and was told to put the rocking chair by a window an open the blind and place her cradle by that same window for a bit of indirect sunlight. We did have to go in a few days later for an additional heel stick to make sure all was well. This is medical advice- so I am not going to tell you when the levels are considered high or not. Just relaying my personal experience.

But I did want to share with you a doctor’s opinion-  a well respected pediatrician who is nationally known: http://www.askdrsears.com/topics/breastfeeding/breastfeeding-special-situations/babies-jaundice He states:

Bilirubin levels average 2-3 milligrams higher in breastfed infants than in formula-fed infants (14.8 milligrams versus 12.4 milligrams). The difference is thought to be due to an as-yet unidentified factor in breastmilk that promotes increased intestinal absorption of bilirubin, so that it goes back into the bloodstream rather than moving on to the liver. Higher rates of jaundice in breastfed infants may also be related to lower milk intakes in the first days after birth, because of infrequent or inefficient feeding. It is normal for jaundice to last a bit longer in breastfeeding infants, sometimes until the third week after birth.

In most cases, it is not necessary to treat jaundice when bilirubin levels are less than 20 milligrams.

And with so many labors being augmented or induced with the use of Pitocin it is important to also understand that,

Pitocin use also increased the likelihood of jaundice in the baby.  http://pregnancy.about.com/cs/breastfeeding1/l/blbfchoice.htm

Prematurity also increases the risks of jaundice since the premature baby has more difficulty processing bilirubin in an immature liver.

If you want to read the American Academy of Pediatrics guidelines- you can read the details here: http://aappolicy.aappublications.org/cgi/content/full/pediatrics;114/1/297

And in a AAP bulletin on normal serum bilirubin levels and breastfeeding this is what is stated:

There is a strong association between breast-feeding and jaundice in the healthy newborn infant. Investigations for the cause of hyperbilirubinemia in healthy breast-fed infants may not be indicated unless the serum bilirubin level exceeds approximately 15 mg/dL, whereas in the bottle-fed infant, such investigations may be indicated if the serum bilirubin exceeds approximately 12 mg/dL. If phototherapy is ever indicated in healthy term infants, the overwhelming majority of such infants are likely to be breast-fed; if breast-feeding is, indeed, the cause of such jaundice, a more appropriate approach to hyperbilirubinemia in the breast-fed infant might be to treat the cause (by temporary cessation of nursing) rather than (using phototherapy to treat) the effect.

http://pediatrics.aappublications.org/content/78/5/837

But breastmilk jaundice is quite rare and the benefits of breastfeeding for the suspicion of this being the rare type of jaundice.  A recommendation by the National Institute of Health states:

Often, the bilirubin level is relatively low (less than 20 mg/dL). Sometimes no specific treatment is needed other than close follow-up.

More frequent nursing (up to 12 times a day) will increase the baby’s fluid levels and can cause the bilirubin level to drop. Ask your doctor before giving your newborn extra formula.

http://www.nlm.nih.gov/medlineplus/ency/article/000995.htm

I can’t tell you what is normal- again a medical assessment- but the articles all seem to state 2o is a level that needs treatment. I am unclear as to what constitutes too high. But if you are going to a hospital that your pediatrician does not attend, perhaps having a conversation with him or her beforehand on the treatment of jaundice and how they would handle things is a good idea to consider.

I am of the opinion that if the baby needs treatment, we need to do everything possible to keep the baby at the breasts and in the mom’s arms. Often times your insurance will pay for light treatment in your home and your pediatrician will welcome blood levels done in their office. Consider all of your options.