Without knowing the total and indirect bili levels for this baby during
that 3 week period, it is difficult to say what the cause might be. In most
newborn jaundice, the indirect bili is elevated. If it is the direct bili
that is high (much more unusual), then it may involve a liver problem.  It
is very unusual for purely breastmilk jaundice to present so quickly and
with such high levels. It is possible that there was a non-breastmilk
related jaundice in the beginning and then a true breastmilk jaundice
super-imposed on that later. For instance, baby may not have been nursing
well the first few days postpartum, or had a blood incompatibility with the
mother or a combination which led to the initially high levels. As baby
began to receive more breastmilk, then a breastmilk jaundice may have
developed which prolonged the hyperbilirubinemia.

If baby remains exclusively breastfed, breastmilk jaundice can persist for
weeks and even months. However, there is no evidence of harm from this type
of jaundice if the bili remains below accepted toxic levels, which it
almost always does.

Note that once bilirubin levels reach the 20-25 mg/dl range in a healthy
newborn (even lower for a premature or otherwise compromised baby), the
danger of kernicterus becomes a serious issue. At these levels, indirect
bilirubin can bind to brain tissue causing irreversible damage. This is
most often seen when baby is born with an elevated bili and the levels
continue to rise rapidly after birth due to blood hemolysis (breaking apart
of the cells). The most common reason for this is a blood incompatibility
between mother and baby, such as seen when Rh-negative mothers(with
Rh-positive babies) have not received Rhogam. However, that is not seen
with a first pregnancy. ABO incompatibilities can lead to elevated bili
(even during a first pregnancy) as well as other less well known antibodies
that can cause a similar reaction.

It would behoove this mother to discuss with her HCP in depth what might
have been the cause of the high bili levels in her first baby. This mother
needs to find out exactly what did happen with the first baby and not
assume that it was only breastmilk jaundice. Most mothers are screened for
antibodies in their blood during pregnancy, so if this is an issue it
should be monitored by the HCP so problems can be discovered before birth.
If it was a problem with normal physiologic jaundice exaggerated by lack of
feeding, then better breastfeeding management immediately post-partum could
be very helpful. Did the first baby have some kind of TT? That could have
contributed to the problem or perhaps mom has underlying issues pertaining
to milk supply. If she works with an IBCLC or experienced counselor while
pregnant, they could devise strategies to deal with the most likely issues
and prevent a recurrence of the problems.

Sharon, BfUSA counselor

On Wed, Mar 11, 2015 at 11:32 AM, Shanti Volpe <[log in to unmask]> wrote:

> Hi! I hope you are all well. I have a question about breastmilk jaundice.
> If a mother had a baby with breastmilk jaundice in the past does that
> increase the likelihood of her subsequent babies having it? What is the
> best current research out there about this topic? This mother had a baby
> with 23.5 bili on day 4 and then continued to have high levels for 3 weeks
> and was hospitalized twice. Although Dr's recommended formula mother
> declined and baby was kept exclusive. Should her next baby be monitored
> more closely and would early intervention prevent levels from spiking so
> high? What type of early intervention is recommended? Are there any
> preventative things this mother can do? Has anyone heard of using
> homeopathy as a preventative? Any other thoughts would be helpful. Thanks
> for your time.
>
>
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