https://breastfeeding.about.com/od/babyhealthissues/a/bfjaundice.htm
https://www.sciencedaily.com/articles/c/colostrum.htm
"Newborns have very small digestive systems, and colostrum delivers its nutrients in a very concentrated low-volume form.
It has a mild laxative effect, encouraging the passing of the baby's first stool, which is called meconium.
This clears excess bilirubin, a waste product of dead red blood cells which is produced in large quantities at birth due to blood volume reduction, from the infant's body and helps prevent jaundice. Colostrum contains large numbers of antibodies called "secretory immunoglobulin" (IgA) that help protect the mucous membranes in the throat, lungs, and intestines of the infant
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https://www.bestforbabes.org/fast-facts-how-to-deal-with-common-breastfeeding-issues
"Common Breastfeeding Issues
Jaundice
**We start with jaundice because it is a well-known newborn condition that can really shake the boat of new parent bliss. (Others include: maternal fever, sore nipples, breast implants and reductions, baby’s low blood sugar (hypoglycemia), and insufficient milk supply, and we will cover these later so keep checking back!) In fact, jaundice gets a “bad rap” as being an undesirable result of breastfeeding, and therefore, often results in replacing breastfeeding with formula, partially, or even completely. Lots of myth and misguided advice surround how to avoid and treat jaundice. Here we give you the information and the tools to navigate your way safely through this condition, should it arise.
What is jaundice? Most jaundice is a normal newborn process experienced by about 60% of all healthy newborns (MacMahon et al, 1998) and and does not usually require formula supplementation or that breastfeeding be interrupted. ( AAP,2004). See
www.aappolicy.aappublications.org/cgi/content/full/pediatrics;114/1/297 and our section Supplementing below. Jaundice is not considered dangerous to your baby in its non-severe form. Jaundice is a yellow coloring of the skin and whites of the eyes caused by a build up of bilirubin (a breakdown product of excess red blood cells) in the blood, usually appearing during baby’s first 2 to 5 days of life. It typically clears on its own in about a week through frequent (at least 8-10 times per day) breastfeeding which causes your baby to stool and eliminate the bilirubin from its body.
What can I do to prevent severe jaundice? In most cases, jaundice levels can be kept within the normal range by following the basic steps to successful breastfeeding: initiating breastfeeding within the first hour of baby’s birth, feeding the baby on cue (this means “baby-led,” frequent and unscheduled feedings — at least 8-10 times per 24 hours), keeping baby with you during your hospital stay, and lots of skin-to-skin contact. Make sure your baby is really swallowing as frequent breastfeeding will not lower bilirubin levels unless the baby is actually taking in colostrum and milk. If you are not sure that the baby is swallowing, get the hospital IBCLC (Internationally Board Certified Lactation Consultant) or a private LC to observe a feeding. See our Get Your Best Game On Game Plan for more details on how to get breastfeeding off to a great start.
Are there any special risk factors for jaundice I should know about? YES.
Babies who are not latched well are at an increased risk for developing higher jaundice levels because they are not transferring, or getting enough, milk. To make sure the baby is latched correctly (corner of mouth open 160 degrees), and is really swallowing colostrum, you can listen for the swallow, or look for the baby’s jaw to drop and hold for a fraction of a second. If you cannot tell whether the baby is swallowing, get the the hospital or an independent LC to help you.
Babies who are the product of deliveries with lots of medications and interventions, ie., forceps, vacuum extractions (Hall et al, 2002), and c-sections (Dewey et al, 2003) sometimes don’t nurse well initially (Smith, 2007).
Late preterm infants (born between 34-37 weeks gestation) are at a much higher risk for jaundice because they are usually sleepier than full-term babies and often don’t feed well (Watchko, 2003; Sarici et al, 2004).
Mothers who are diabetic are at a higher risk of delivering at 34-37 weeks (Lepercq, 2004), and therefore, their babies are at higher risk for jaundice.
What should my game plan be if I deliver between 34 and 37 weeks or I am diabetic?
•Late preterm infants (born between 34 and 37 weeks) and even those born between 37 and 39 weeks need at least 10-12 feedings per 24 hours (Meier et al, 2007).
•Late preterm infants are easily overwhelmed by bright lights, noise, and visitors. You should ask friends and family to limit or avoid visiting for the first 2 weeks until you and your baby are in a good breastfeeding groove. Please don’t interrupt or postpone breastfeeding because of visitors!
•If you are diabetic, consider hand expressing colostrum and freezing it before the baby is born (your boobs are at the ready long before birth), and bring it to the hospital to feed to the baby if he/she does not latch or experiences significant hypoglycemia (low blood sugar levels) (Cox, 2006).
What if the jaundice does require additional medical treatment? If the bilirubin levels continue to rise beyond moderate levels, phototherapy may be recommended. This light therapy can be provided through a special set of lights, a blanket, or a band. If you are still in the hospital, ask that the phototherapy be done in your room. Sometimes your baby may be sent to the special care nursery. Most of the time, this does not mean that you need to stop breastfeeding or supplement with formula! (Gartner 2001)
What should my game plan be if my baby needs extra medical care in the nursery? If your baby is in the special care nursery, your colostrum can be drawn up into a syringe and fed to the baby. You will need to consider pumping milk if your baby is born before 37 weeks –preterm or preemie. See above Game Plan.
What are the signs indicating a potential problem? Since many babies are released from the hospital at 1 or 2 days of life, before your milk comes in fully, some problems become more apparant once you are home. This is another good reason to see an LC before you are discharged and to have the name and number of one who can give you excellent follow-up help once you are home.
Call your baby’s doctor if your baby:
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Refuses breastfeeding or bottle feeding;
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is sleepy all the time –lethargic or limp
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Has lost a significant amount of weight (more than 10% of her weight at birth); or
•Is extremely jaundiced (trunk, arms and legs are a yellow or orange color)
•Develops a fever over 100 degrees
•Has only a few wet diapers or stools (
on day 3, <4 on day 4)
If you your pediatrician discovers high bilirubin levels at about day 3, you should be seen immediately by a lactation specialist to find out why your baby is not transferring milk.
What if the hospital or doctor recommends that my baby be supplemented? You shouldn’t have to discontinue breastfeeding altogether, or resort immediately to a bottle of formula, to resolve jaundice. Supplementing with formula is not the only or even preferable way to fix rising bilirubin levels. You have options here:
Best plan: You get the hospital or an independent lactation consultant involved and have her show you how to supplement your baby with your expressed (by hand or by pump) milk or colostrum with a spoon, cup, or even at the breast via an infant feeding tube (oral).
Second-best plan: If, for whatever reason, you cannot express enough milk/colostrum, then small amounts of screened, pasteurized donor human milk can be substituted. At the same time continue to stimulate the breasts to make milk by hand expressing or pumping.
Third-best plan: If the hospital does not keep a small stash of banked human milk on hand for these occasions, a hydrolyzed formula, not a standard one, can be substituted for your milk. Hydrolyzed formula helps reduce the risk for sensitizing a susceptible baby to allergies or diabetes. Continue to stimulate the breasts to make milk by hand expressing or pumping, so that when any latch difficulties have been solved, you are making enough milk for your baby.
Note that formula is the choice of last resort according to this evidence-based recommendation.
- See more at: https://www.bestforbabes.org/fast-facts-how-to-deal-with-common-breastfeeding-issues#sthash.t9JEbbC4.dpuf"
If you do give formula,. use a DRopper or a Nursing System, as this will not cause nipple confussion and be the most breastfeeding friendly option. We did give our daughter formula in the hospital for this reason, Had I knew what we now know. We would not have ever gave her formula.
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