![]() Mothers do not initially produce sufficient quantities of milk for the demand-fed infant unlike bottle-fed infants who are given calculated amounts at regular intervals. Feeding stimulates the gastrocolonic reflex and increases intestinal motility, clearance of meconium and conjugated bilirubin from the gut. ![]() The impact of feeding frequency can be a contributing cause of jaundice in the breastfed baby. The use of early versus late onset is preferred by many over using the terms physiological or pathological jaundice. It is important not to imply that breast milk jaundice is harmful, thereby influencing a mother’s choice not to breastfeed. ![]() There is controversy in the literature as to how to classify breast milk jaundice. Causes of physiological and pathological jaundice can be linked to each stages of metabolism ( Table 64.2). Pathological jaundice can present on day 1 or it can be prolonged, persistent after day 14 in the term infant or day 21 in the preterm infant. Pathological jaundice, on the other hand, should raise concern and always requires further investigation. Serum bilirubin (SBR) levels will peak by day 4 and reduces by day 14. Jaundice is classified as physiological or pathological. Physiological versus pathological jaundice Alterations at any of these stages can result in jaundice ( Table 64.1). There are four stages involved in bilirubin metabolism. In order to provide informed care for a jaundiced baby and parents it is important to have an understanding of bilirubin metabolism. Jaundice in the newborn is common, occurring in over two-thirds of term infants and even more frequently in the preterm infant. Jaundice occurs when bilirubin accumulates in the extravascular fatty tissues (skin and brain). ![]()
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