What is the most critical physiologic change required of the newborn after birth?

Most newborns with jaundice can continue breastfeeding. Decisions about supplementation of a jaundiced newborn should be made on a case-by-case basis.

Jaundice, a sign of elevated bilirubin levels, is common during the first weeks of life, especially among preterm newborns. Bilirubin, a product from the normal breakdown of red blood cells, is elevated in newborns for several reasons:

• Newborns have a higher rate of bilirubin production due to the shorter lifespan of red blood cells and higher red blood cell concentration compared to adults.
• Newborns have immature liver function, leading to slower metabolism of bilirubin.
• Newborns may have a delay in passage of meconium, leading to increased reabsorption of bilirubin in the intestines.
• In most newborns, jaundice is termed “physiologic jaundice” and is considered harmless.

What is the difference between suboptimal intake jaundice and breast milk jaundice?

Suboptimal intake jaundice, also called breastfeeding jaundice, most often occurs in the first week of life when breastfeeding is being established. Newborns may not receive optimal milk intake, which leads to elevated bilirubin levels due to increased reabsorption of bilirubin in the intestines. Inadequate milk intake also delays the passage of meconium, which contains large amounts of bilirubin that is then transferred into the infant’s circulation. In most cases breastfeeding can, and should, continue. More feedings can reduce the risk of jaundice.

Breast milk jaundice most often occurs in the second or later weeks of life and can continue for several weeks. While the exact mechanism leading to breast milk jaundice is unknown, it is believed that substances in the mother’s milk inhibit the ability of the infant’s liver to process bilirubin.

Phototherapy is a common treatment for jaundice. Other therapeutic options include temporary supplementation with donor human milk or infant formula, and rarely, temporary interruption of breastfeeding.

Should a mother continue breastfeeding if her child has jaundice?

Supplementation can include mother’s expressed breast milk, pasteurized donor human milk, or infant formula.

Usually. Most newborns with jaundice can continue breastfeeding. More frequent breastfeeding can improve the mother’s milk supply and, in turn, improve caloric intake and hydration of the infant, thus reducing the elevated bilirubin. In rare cases, some infants may benefit from a time-limited, temporary interruption (12-48 hours1,2) of breastfeeding with replacement feeding to help aid in the diagnosis of breast milk jaundice. Ongoing clinical assessment, including repeat bilirubin levels, will help determine when breastfeeding can resume. Further guidance is outlined in the Academy of Breastfeeding Medicine’s clinical protocols on supplementationexternal icon and jaundiceexternal icon. If temporary breastfeeding interruption is required, it is critical to help mothers maintain their milk production during this time.

Should a jaundiced breastfed infant be supplemented?

Sometimes. Jaundice is one of the possible indications for supplementation in healthy, term infants as outlined in the Academy of Breastfeeding Medicine’s clinical protocols on supplementationexternal icon and jaundiceexternal icon.  Any decisions about supplementation of a jaundiced newborn should be made on a case-by-case basis.

• Wambach, K. & Riordan, J. (2015). Breastfeeding and Human Lactation (5th ed.). Jones & Bartlett Learning. Page 405.
• Lawrence, R.A & Lawrence, R.M. (2016). Breastfeeding: A Guide for the Medical Profession (8th ed.). Philadelphia, PA: Elsevier. Page 506.

Chapter 23: Physiologic and Behavioral Adaptations of the newborn

the Newborn

Lowdermilk: Maternity & Women’s Health Care, 11th Edition

MULTIPLE CHOICE

1. A woman gave birth to a healthy 7-pound, 13-ounce infant girl. The nurse suggests that the

client place the infant to her breast within 15 minutes after birth. The nurse is aware that the

initiation of breastfeeding is most effective during the first 30 minutes after birth. What is the

correct term for this phase of alertness?

a.Transition period

b.First period of reactivity

c.Organizational stage

d. Second period of reactivity

ANS: B

The first period of reactivity is the first phase of transition and lasts up to 30 minutes after

birth. The infant is highly alert during this phase. The transition period is the phase between

intrauterine and extrauterine existence. An organizational stage is not a valid stage. The

second period of reactivity occurs approximately between 4 and 8 hours after birth, after a

period of sleep.

DIF: Cognitive Level: Understand REF: p. 523 TOP: Nursing Process: Planning

MSC: Client Needs: Health Promotion and Maintenance

2. Part of the health assessment of a newborn is observing the infant’s breathing pattern. What

is the predominate pattern of newborn’s breathing?

a.Abdominal with synchronous chest movements

b. Chest breathing with nasal flaring

What are the physiological changes in the newborn immediately after birth?

What is most important need for newborn immediately after birth?

What are four major physiological changes that occur during infancy?

What are the most common newborn complications?