母乳餵養與新生兒黃疸

黃疸（也叫膽紅素血癥）是造成新生兒皮膚和眼球呈黃色的原因，尤其在最初的一、兩週裏。 因此，當醫生懷疑寶寶的黃色不止是由於生理性黃疸造成的時候，就會開始用血樣密切監測膽紅素水平。如果膽紅素水平太高，醫生可能會嘗試採用光療法來降低膽紅素水平。採用光療法時，特殊的光線可以溶解皮膚上多餘的膽紅素，允許這些膽紅素通過尿液排出體外。 爲什麼對於母乳寶寶來說黃疸會是一個問題？
母乳餵養的寶寶比配方奶餵養的寶寶的膽紅素水平平均會高2-3毫克（14.8毫克比12.4毫克）。這個差異被認爲是由於母乳中一些尚未確定下來的物質的存在，這種物質會增加腸道對於膽紅素的吸收，使膽紅素重新進入血流而不是進入肝臟。另外，母乳寶寶出生後的第一天由於哺乳時間和次數的不足造成乳汁攝入太低，也是一個原因。因此對於母乳寶寶來說黃疸持續的時間更長一些，有時會持續到第三週。 大多數的新生兒黃疸對寶寶來說是無害的，而通常的治療手段卻會干擾正常的母乳餵養。因此，醫護人員和父母們應該注意治療可能會帶來比疾病本身更大的問題。 當膽紅素水平低於20毫克時，大多數時候沒有必要採取措施。 大部分的患黃疸的嬰兒不需要添加水、糖水或者配方奶。 停1-2天母乳通常也是沒有必要的。 Shake off any suggestion that something about your milk is bad for your baby. As long as your baby is otherwise healthy, jaundice is short-lived and harmless. If your baby's jaundice is related to other health problems, your milk is very valuable for him and you should continue to breastfeed.  也許有人會說是母乳讓情況變糟的，不要去理睬這樣的說法。只要寶寶其它方面都是健康的正常的，黃疸只是短時間而無害的。如果寶寶的黃疸是由於某些健康問題造成，那你就更應該繼續哺乳，你的母乳對寶寶來說是非常寶貴的。 順利地哺乳對於降低膽紅素水平，避免黃疸所帶來的問題，是非常重要的。 早吸吮、頻繁地不設限地哺乳，有助於消除寶寶身體裏的膽紅素。膽紅素從嬰兒的大便中排出體內，頻繁哺乳的新生兒可能會有許多次大便，這樣就可以降低膽紅素的 黃疸有時會讓寶寶睡得比較多，不大喜歡吃奶。你可能必須喚醒他鼓勵他多吃奶。 If phototherapy treatment is necessary because of a high bilirubin level, talk to your healthcare provider about alternatives to placing baby in the hospital nursery under phototherapy lights. For most babies a photo-optic bilirubin-blanket (phototherapy lights that wrap around the baby) works well. You can hold and breastfeed your baby at home while the lights dissolve the bilirubin.
Giving breastfed babies bottles of sugar water in hopes of reducing bilirubin levels has been shown to be ineffective. It may even aggravate the jaundice, because babies whose tummies are full of glucose solutions may nurse less often, reducing their milk intake and the opportunities for bilirubin to be excreted in stools.
If your doctor advises giving formula supplements to provide more fluids and calories and decrease the intestinal absorption of bilirubin, work with a lactation consultant to give supplements via a supplementary nursing system, syringe, or finger-feeding methods. See "Alternatives to bottles". This will avoid problems with nipple confusion.
Don't worry, make milk. If your baby is jaundiced, be sure you understand what type of jaundice your baby has. If it's normal physiologic jaundice, you have absolutely nothing to worry about. If it's jaundice due to a medical cause, such as a blood group incompatibility, be sure you understand that this is easily treated and should not interfere with your breastfeeding. Worry may cause you to make less milk and doubt your ability to nourish your baby at the breast. This gets in the way of breastfeeding success.
PROLONGED JAUNDICE
In some breastfed babies, bilirubin levels may exceed 20 milligrams and jaundice may last well into the second week of life or longer. It was once thought that this was a distinct type of jaundice, called breast milk jaundice, that was found in a small group of mothers whose milk contained a substance believed to interfere with bilirubin absorption. Treatment for this type of jaundice involved taking baby off the breast for 24 to 48 hours. This brought bilirubin levels down, but sabotaged the course of breastfeeding. More recent research suggests that high bilirubin levels and prolonged jaundice in otherwise healthy breastfed babies are just normal variants of ordinary physiologic newborn jaundice. There may well be a substance in the milk of most mothers that inhibits the absorption of bilirubin by the intestines, but whether a baby has a little jaundice or a lot is largely due to individual differences in both babies and mothers. Nevertheless, some healthcare providers may suggest a period of temporary weaning (24 to 48 hours) to bring down bilirubin levels. Work with your doctor to determine if there are other alternatives, for example, phototherapy, that would allow breastfeeding to continue without restrictions. If you do decide to try formula for a day or two, be sure to pump your breasts every two to three hours so that you will continue to make milk and avoid a breast infection. Formula supplements can be given using alternatives to bottles, to avoid problems with nipple confusion when baby returns to the breast.