Anemia of Prematurity - Portal Neonatal

Breast milk jaundice
Breast milk jaundice is different from breastfeeding jaundice in that unconjugated bilirubin levels in the
serum continue to increase during the first 2 weeks. With breast milk jaundice, the unconjugated
bilirubin level typically peaks between days 5 and 15 after birth, and they usually return normal levels
by the end of the third week. However, elevated levels that persist into the third month are not
uncommon.
Interrupting breastfeeding in an otherwise healthy infant is not recommended unless the serum
bilirubin concentration exceeds 20-22 mg/dL. The cause of breast milk jaundice is still not clear, an
inhibitor of hepatic glucuronyl transferase is thought or exists, and/or the enterohepatic circulation of
bilirubin increases. Other more rare forms of unconjugated hyperbilirubinemia, such as Crigler-Najjar
syndrome (ie, glucuronyl transferase deficiency), should be considered if the bilirubin level remains
elevated after the infant's first month of life.
RECOGNITION AND MANAGEMENT OF COMMON
BREASTFEEDING PROBLEMS
Risk factors for breastfeeding difficulties
Section 9 of 11
Mother-infant pairs who are at risk for breastfeeding difficulties should have closer follow-up care. Risk
factors in the mother include a history of poor breastfeeding with a previous newborn, flat or inverted
nipples, abnormal breast appearance, previous breast surgery, previous breast abscess, extremely
sore nipples, minimal prenatal breast enlargement, failure of the milk to come in abundantly after
delivery, and chronic or severe medical problems. Breastfeeding risk factors in the infant include small
size or prematurity, poor sucking, any oral abnormality, multiple gestation, medical problems, or
neurologic or muscle-tone problems.
Common breastfeeding problems and solutions
Common breastfeeding problems and their solutions include the following:
• Engorgement: The treatment is prevention with frequent breastfeeding.
• Areolar engorgement: Treatment involves the manual expression or pumping of milk to soften
the areola and allow better latch-on
• Mammary vascular engorgement: Treatment involves frequent breastfeeding around the
clock, the application of cabbage leaves, and manual or electric pumping.
• Sore nipple: This problem is commonly associated with improper latch-on. Help the mother
with positioning and encourage her to insert the areola and nipple into the infant's open
mouth.
• Cracked nipple: The mother should begin the breastfeeding session on the less-affected side.
Placing a drop of milk on each nipple and allowing this to air dry after breastfeeding may help.
The use of high-grade lanolin or nipple shields should be considered if bleeding occurs.
• Mastitis: This problem is more common in engorged breasts. The mother should continue to
breastfeed while taking antibiotics. Frequent emptying of the breast is essential for relief and
recovery. The mother may also take acetaminophen or ibuprofen for relief.
• Abscess: This problem typically requires surgical incision and drainage, as well as antibiotics.
The mother should continue to breastfeed on the unaffected side and pump the affected side
to relieve pressure and facilitate recovery. The infant may be breastfed on the affected side
when the breast is no longer painful to touch. Analgesia is essential for mother's comfort.
• Yeast infection of the breast: Candida albicans, which causes thrush in infants, may infect the
nipple and intraductal system. Complaints of the mother include pain during breastfeeding or a
diminution of her milk supply. Culture samples obtained from the skin. Treatment may begin
with topical nystatin, but systematic therapy may be required for eradication.