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Optimal practice review: recommendation reminders detail

Recommendation reminder 2: Breastfed babies with jaundice should not be routinely supplemented with formula, water or dextrose water.

Guidance:Postnatal care
Date issued:July 2006

Postnatal care refers to the care of women and their babies in the first 6–8 weeks after birth. Because each woman and baby has different needs, the postnatal care they receive will vary.

For most women and babies the postnatal period is uncomplicated and postnatal care is primarily about providing a supportive environment in which a woman, her baby and the wider family can begin their new life together. Postnatal care is also about ensuring that the mother and baby are recovering normally after the birth and being able to quickly identify and deal with any problems that might occur.

The majority of postnatal care takes place in the woman’s home and is likely to include routine clinical examination and observation of the woman and her baby, routine infant screening to detect potential disorders, support for infant feeding and ongoing provision of information and support.

Approximately half of all infants who are not born prematurely will develop jaundice during the week after they are born. Jaundice is a yellowing of the skin and the whites of the eyes. It is caused by the build up of bilirubin, a chemical substance produced in the body when the red blood cell’s oxygen carrying molecule haemoglobin is broken down. Normally, the liver processes bilirubin allowing it to be filtered by the kidneys and excreted (passed out) from the body in urine.

In newborn babies, jaundice can occur as a result of the liver being underdeveloped and not fully functional. Most jaundice will not harm the baby and requires no treatment, but high levels of bilirubin (hyperbilirubinemia) can be toxic or may indicate a more serious problem. Possible treatments for high levels of bilirubin include phototherapy (exposure to ultraviolet light) and hydration.

Jaundice was included in the NICE Guideline Development Group’s review of several common health problems in infancy. Overall they found that the available evidence was not robust and therefore where evidence was lacking they agreed on ‘good practice recommendations’.

In the evidence reviewed, one study randomised 50 breast fed infants with hyperbilirubinaemia to either continued breast feeding with phototherapy or to interruption of breast feeding and substitution of breast milk with infant formula. They found no significant difference in the maximum reached bilirubin levels between the groups..

The American Academy of Pediatrics (AAP) recommends against routine supplementation of non-dehydrated breastfed infants with water or dextrose water because the harms are likely to exceed the benefits. Therefore, based on this advice and the lack of robust evidence on supplementation in breastfed babies with jaundice, NICE recommends that these infants should not routinely receive supplementation with formula, water or dextrose water.

NB: A clinical guideline on Neonatal Jaundice will be published by NICE in April 2010.

This page was last updated: 15 October 2009

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Accessibility | Cymraeg | Freedom of information | Vision Impaired | Contact Us | Glossary | Data protection | Copyright | Disclaimer | Terms and conditions

Copyright 2014 National Institute for Health and Care Excellence. All rights reserved.