Newborn care: 12 beliefs that shape practice (But should they?)

BELIEF 12: Breast-milk jaundice is best treated by stopping breastfeeding for 24 to 48 hours

THE EVIDENCE: breastfeeding should not be discontinued as a way to treat breast-milk jaundice (SOR: C).

In fact, breastfeeding should not be discontinued for jaundice due to any cause, as demonstrated in the opening scenario, unless you believe a baby is at risk of requiring an exchange transfusion. The need for phototherapy alone is not a sufficient reason to discontinue breastfeeding.⁵

Breast-milk jaundice is a common problem facing parents and physicians, but it is not a disease and does not represent an abnormality in and of itself. Rather, this normal physiologic condition gains its importance only in that it must be distinguished from pathological causes of newborn jaundice.²⁹ Breast-milk jaundice is believed to affect 1%²¹to 33%³⁰ of breastfed infants.

One treatment measure—to stop breastfeeding—began, in part, as a cost-effective way to diagnose breast-milk jaundice.³¹ Rechecking the bilirubin 24 to 48 hours after breastfeeding is discontinued would reveal a significant drop in the bilirubin level, confirming the diagnosis of breast-milk jaundice³² and obviating the need for testing for more serious medical illness.

The consequence of this misguided treatment approach, ie, discontinuing breastfeeding, is that some mothers are more likely to stop breastfeeding altogether.³³

Acknowledgments

The authors thank the following individuals for providing assistance with this manuscript: Mariateresa Esquivel, MD; Charlotte Hobbs, MD, PhD; Christopher Monnikendam, MD; and Clare Campbell Nesmith, MD.

Funding/Support

Dr Hall receives funding through DHS 1 P20 RR020146-01.

Correspondence
Bryan L. Burke, Jr., MD, FAAP, Associate Professor, Pediatrics and Neonatology, University of Arkansas for Medical Sciences, Arkansas Children’s Hospital, 4301 West Markham, Slot # 512-5B, Little Rock, AR 72205; burkebryanl@uams.edu