Conditions Often Associated With Breastfeeding

Hypoglycemia

Hypoglycemia in breastfed newborns and infants is a commonly cited concern among physicians.  

• Healthy full-term newborns and infants with normal feeding patterns have adaptions to prevent problematic hypoglycemia.
• Newborns and infants most at risk are small or large for gestational age, late preterm, or born to mothers who are diabetic.
• Reducing the occurrence of hypoglycemia can be facilitated by
  • Encouraging skin-to-skin care
  • Improving milk intake by early and frequent breastfeeding
• The AAP recommends screening for hypoglycemia in symptomatic or at-risk newborns and infants only.
  • Routine supplementation of healthy, asymptomatic breastfed newborns and infants to prevent hypoglycemia is not indicated.
  • Manage mild hypoglycemia with prompt feeding. 

Breastfeeding Jaundice

• Newborns who are not feeding well are at risk of breastfeeding jaundice, more accurately called suboptimal intake jaundice.
  • Usually occurs in the first week after birth.
  • Low milk intake, relative dehydration, delayed passage of bilirubin-rich meconium, and an active enterohepatic circulation of bile may lead to elevated bilirubin. 
  • Newborns with increased rates of bilirubin production caused by hemolytic processes (eg, ABO incompatibility, glucose-6-phosphate dehydrogenase deficiency) or bruising may be at increased risk.
  • Newborns with immaturities in conjugating bilirubin (typically seen in Asian or late-preterm newborns or those with Gilbert syndrome) may also have jaundice in the early days after birth.
• Prevention of breastfeeding jaundice is key.
  • Encourage exclusive and frequent breastfeeding at least 8 to 12 times per day, avoid water or unnecessary formula supplements, and teach mothers proper latch technique to help prevent poor intake, excessive weight loss, and jaundice.
• There is never a need to interrupt breastfeeding.
  • An appropriate response is to optimize intake by improving milk transfer, by having the mother express milk to increase milk intake, or with the judicious use of pasteurized donor milk or formula supplements for newborns with significant hyperbilirubinemia.
  • Supplementation is not routinely indicated.  

Breast Milk Jaundice

Jaundice that occurs in healthy, thriving breastfed newborns and infants usually beyond the second week after birth is known as breast milk jaundice (BMJ).  

• In BMJ, serum unconjugated bilirubin remains elevated, and a few infants may have elevated concentrations for as long as 6 to 12 weeks.
  • By week 3, 2/3 of healthy, thriving breastfed newborns have serum bilirubin concentrations above 1.5 mg/dL, and 30% are clinically jaundiced.
  • In contrast, formula-fed newborns’ serum bilirubin declines to less <1.5 mg/dL by day 11 or 12 after birth.
• This elevation in serum bilirubin is a normal response to breastfeeding, and other than the presence of jaundice, newborns with BMJ seem healthy. 
• The cause of BMJ is unknown, but factors in human milk that increase the enterohepatic cycle of bilirubin or genetic variations that impair bilirubin hepatic conjugation may play a role. 

Breastfeeding should be continued and the parents reassured.