Presentation
Variations in current treatment are presented and nursing measures supportive of parents and continued breastfeeding are provided. [ohsu.pure.elsevier.com]
Most of the proposed etiologies involve factors present in the human breast milk itself. Another area of investigation has been the potential genetic mutations present in the affected newborns. [ncbi.nlm.nih.gov]
Respiratoric
-
Tachypnea
[…] more than 0.5 mg/dL/h Pallor, hepatosplenomegaly Ethnicity suggestive of G-6-PD deficiency Failure of phototherapy to lower bilirubin level Factors that suggest the possibility of sepsis: Poor feeding Vomiting Lethargy Temperature instability Apnea Tachypnea [medcaretips.com]
Gastrointestinal
-
Overeating
Breast milk jaundice is thought to be caused either by enzymes in momâ s milk that deactivate the babyâ s enzyme for dealing with bilirubin or by fatty acids in momâ s milk that the baby processes as a priority over processing the bilirubin. [drgreene.com]
In the usual situation, even if the mother continues to nurse, the bilirubin levels will fall to normal gradually over a period of 3 to 10 weeks. [drhull.com]
These manifestations may develop slowly (over several days) or be fulminant (in a matter of hours) and can potentially result in acute bilirubin encephalopathy. [contemporarypediatrics.com]
[…] investigation and persistent hyperbilirubinaemia above 200 µmol/l (12 mg/dl), then consider the possibility of the additional presence of an UGT 1A1(uridine diphosphate glucuronosyltransferase 1A1) mutation or G6PD deficiency for total serum bilirubin over [gpnotebook.co.uk]
Skin
-
Yellow Discoloration of the Skin
These may include: yellow discoloration of the skin and the whites of the eyes fatigue listlessness poor weight gain high-pitched crying Infants are born with high levels of red blood cells. [healthline.com]
Jaundice is a yellow discoloration of the skin and eyes caused by hyperbilirubinemia (elevated serum bilirubin concentration). [merckmanuals.com]
-
Purpura
[…] hemorrhage Physiologic jaundice Polycythemia Sepsis Hemoglobinopathies: thalassemia Red blood cell enzyme defects: G6PD Deficiency, pyruvate kinase Red blood cell membrane disorders: spherocytosis, ovalocytosis Hypothyroidism Immune thrombocytopenic purpura [wikem.org]
-
Flushing
Giving baby bottles of water or glucose water to “flush out” the jaundice is no longer recommended. Bilirubin is eliminated in baby’s stools. [llli.org]
Neurologic
-
Lip Smacking
Teach the mother to respond to the earliest cues of infant hunger, such as moving about or restlessness, lip smacking, hand movements toward the mouth, and vocalizing. Most newborns need to be fed every 2 ½ to 3 hours. [liebertpub.com]
Workup
galactosemia, tyrosinosis) Evaluation The most important component of the workup is differention of direct vs indirect bilirubinemia See BiliTool and the phototherapy guide for total bilirubin cutoff by age recommendations History extremely important [wikem.org]
An additional workup for hyperbilirubinemia may include: Blood group and direct Coombs testing in babies who are at risk of Rh or ABO isoimmunization. [pathophys.org]
Ultrasound
-
Enlargement of the Spleen
On physical examination by a physician or nurse practitioner, the liver is usually enlarged and the spleen is also often enlarged as well. Case study The baby in this photo is 7 weeks old. He was born slightly premature at 36 weeks gestation. [ibconline.ca]
Treatment
Continuing to breastfeed during your baby’s treatment or after treatment is finished will not cause their bilirubin problems to return. If you have questions about breastfeeding a baby with jaundice, reach out to your healthcare provider. [medelabreastfeedingus.com]
Monitoring newborns’ bilirubin levels can help identify the underlying cause and enable early treatment. Breastfeeding generally can and should continue throughout treatment. [llli.org]
Treatment for this condition is fairly simple, and there is no need to stop breastfeeding. [birthinjuryhelpcenter.org]
Variations in current treatment are presented and nursing measures supportive of parents and continued breastfeeding are provided. [ohsu.pure.elsevier.com]
This can be a particular problem among neonates discharged from the hospital within 48 hours, often requiring readmission for treatment of hyperbilirubinemia. [neoreviews.aappublications.org]
Prognosis
View in: PubMed subject areas Bilirubin Breast Feeding Glucosephosphate Dehydrogenase Deficiency Hemolysis Humans Infant, Newborn Jaundice, Neonatal Prognosis Terminology as Topic [profiles.umassmed.edu]
Complications and Prognosis of Breast Milk Jaundice Bilirubin encephalopathy (kernicterus) can occur with persistently high bilirubin levels. Prognosis is generally excellent. Jaundice may persist for as long as 12 weeks. [medcaretips.com]
(Outcomes/Resolutions) Breastfeeding Jaundice has excellent prognosis, in a majority of the cases Some babies with underlying medical conditions may require additional treatment measures, if any complications develop Additional and Relevant Useful Information [dovemed.com]
Prognosis Overall, the prognosis of infants with breast milk jaundice is excellent as it is a self-limited condition that usually resolves around 12 weeks of age. [ncbi.nlm.nih.gov]
Etiology
“Whenever a baby has jaundice beyond 2 weeks of age, the clinician needs to look harder for the true etiological cause.” Dr Bhutani is Professor of Pediatrics, Stanford University, Stanford, California. [contemporarypediatrics.com]
Etiology The exact etiology of breast milk jaundice has not been determined. Most of the proposed etiologies involve factors present in the human breast milk itself. [ncbi.nlm.nih.gov]
Epidemiology
Epidemiology Prevalence Physiologic jaundice: 40–60% of infants BFJ: 10% of breastfed infants BMJ: 0.5–2% of breastfed infants Risk Factors Jaundice in first 24 hours (pathologic) Predischarge elevated total serum bilirubin Blood type incompatibility [unboundmedicine.com]
Epidemiology of neonatal hyperbilirubinaemia Pediatrics, 1985; 75 : 770-774. Google Scholar Sirota, L., Nussinovitch, M., Landman, J. and Dulitzky, F. Breast milk jaundice in preterm infants Clin. Pediatr., 1988; 27: 195-197. [journals.sagepub.com]
Mutations in this gene's regulatory region are known to cause Crigler-Najjar and Gilbert syndrome, two syndromes known to cause persistent hyperbilirubinemia[6] Epidemiology The frequency of breast milk jaundice within the United States is thought to [ncbi.nlm.nih.gov]
Pathophysiology
[…] total serum bilirubin Blood type incompatibility Glucose-6-phosphate dehydrogenase (G6PD) deficiency Gestational age 36 weeks Previous sibling receiving phototherapy Cephalohematoma or significant bruising Exclusive breastfeeding Eastern Asian race Pathophysiology [unboundmedicine.com]
Pathophysiology of Breast Milk Jaundice The cause of breast milk jaundice is not clearly understood, but the following factors have been suggested: Inhibition of Glucuronyl transferase [An enzyme used in the breakdown of bilirubin] Pregnane-3-alpha 20 [medcaretips.com]
Pathophysiology of breastmilk jaundice. In:Polin RA, Fox WW, eds. Fetal and neonatal physiology.Philadelphia:WB Saunders, 1991;1173-9. 2. Suradi R. Hubungan pemberian ASI dengan ikterus pada neonatus. [paediatricaindonesiana.org]
Please see the Medscape Drugs and Diseases article Neonatal Jaundice for an in-depth review of the pathophysiology of hyperbilirubinemia. [emedicine.medscape.com]
high GI obstruction (pyloric stenosis, bowel obstruction) Other causes: medication, hypothyroidism, malnutrition, polycythemia References:[1][2][3] Pathophysiology Pathological hyperbilirubinemia Subtypes and variants Clinical features Physiological [amboss.com]
Prevention
This type can be prevented or treated by encouraging mothers to nurse as often as possible, particularly if bilirubin levels are rising. [ncbi.nlm.nih.gov]
Preventing Newborn Jaundice Jaundice is a naturally occurring condition that most newborns will acquire shortly after being born, so there is no specific way to prevent it. [birthinjuryhelpcenter.org]
However, it may be linked to a substance in the breast milk that prevents certain proteins in the infant’s liver from breaking down bilirubin. The condition may also run in families. [healthline.com]
Breast milk jaundice cannot be prevented. Phototherapy Babies with more severe jaundice may require phototherapy. This means the baby is placed under special lights. [news-medical.net]
Can Jaundice in the breastfed baby be prevented? Jaundice occurs in 50-70% of all newborns, so there is really no way to prevent it from occurring. [americanpregnancy.org]