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Breast Milk Jaundice

BMJ


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]
  • Correspondence to Dr Barbara L Philipp, Department of Pediatrics, Boston Medical Center, 850 Harrison Avenue, YACC-5, Boston, MA 02118–2392, USA; bobbi.philipp{at}bmc.org Abstract The breastfed infant with prolonged unconjugated hyperbilirubinaemia can present[fn.bmj.com]
  • The aim of the present study was to evaluate the effect of breast milk's microbiological content on the development of breast milk jaundice (BMJ). Methods: A total number of 60 mother-infant pairs enrolled to the study.[insights.ovid.com]
  • Fetal and… 2011 The breastfed infant with prolonged unconjugated hyperbilirubinaemia can present a vexing clinical dilemma. Although it is a… (More) Lawrence M.[semanticscholar.org]
Overeating
  • 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]
  • 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]
  • […] 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]
  • I lost all control over my emotions in the parking lot of the doc’s office and called my husband to tell him I will never breastfeed again for as long as I live.”[ibconline.ca]
  • […] level, which naturally rises during the first week of life How fast the bilirubin level has been going up Whether your baby was born early How old your baby is now Often, the bilirubin level is low (20 mg/dL is the usual normal limit for babies who are over[indiatoday.in]
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]

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]
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]
Clostridium Perfringens
  • Reduction of bilirubin ditaurate by the intestinal bacterium Clostridium perfringens. Acta Biochim Pol. 2012;59(2):289-92. PubMed Google Scholar [39] Gartner LM. Breastfeeding and jaundice. J Perinatol. 2001;21 Suppl 1S25-9; discussion S35-9.[degruyter.com]

Treatment

  • Variations in current treatment are presented and nursing measures supportive of parents and continued breastfeeding are provided.[ohsu.pure.elsevier.com]
  • Breast Milk Jaundice complications may develop if the infant is born preterm, or is severely malnourished, or does not get the correct treatment.[dovemed.com]
  • Expectations (prognosis) The baby should recover fully with the right monitoring and treatment. Complications With the right treatment, there are usually no complications.[indiatoday.in]
  • Treatment is via increasing the number of feeds to 10 or more per day. If the neonate still demonstrates poor stooling, formula supplementation may also become necessary.[medicaljoyworks.com]
  • Babies with breast milk jaundice usually recover with the right treatment and careful monitoring.[healthline.com]

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]
  • (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]
  • Expectations (prognosis) The baby should recover fully with the right monitoring and treatment. Complications With the right treatment, there are usually no complications.[indiatoday.in]
  • Prognosis The prognosis is excellent, although jaundice in breastfed infants may persist for as long as 12 weeks. Morbidity Breast milk jaundice in otherwise healthy full-term infants rarely causes kernicterus (bilirubin encephalopathy).[emedicine.medscape.com]

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]
  • The underlying etiology is unknown; it is postulated that certain substances in the maternal milk (e.g. β-glucuronidases, and nonesterified fatty acids) inhibit the normal metabolism of bilirubin, resulting in indirect hyperbilirubinemia.[medicaljoyworks.com]
  • Cause The etiology is unknown but may be related to inflammatory cytokines in human milk and the presence epidermal growth factor. [2] Clinical Features Jaundice within the first 4-7 days of life Differential Diagnosis Indirect (Unconjugated) Hyperbilirubinemia[wikem.org]
  • (Etiology) Red blood cells that get continuously discarded are processed by the liver, resulting in the formation of a yellowish pigment bilirubin.[dovemed.com]

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]
  • […] should avoid consumption of fava beans as well as ingestion of quinine-containing sodas. [23] The presence of these pro-oxidant items in breast milk may induce G6PD crises in the breastfed children, leading to jaundice and/or hemolytic anemia. [23] Epidemiology[emedicine.medscape.com]
  • Kernicterus: Epidemiological strategies for its prevention through systems-based approaches. J Perinatol 2004 ;24:650–662. Crossref, Medline, Google Scholar 68 Maisels MJ, Newman TB. Kernicterus in otherwise healthy, breast-fed term newborns.[liebertpub.com]
Sex distribution
Age distribution

Pathophysiology

  • […] elevated total serum bilirubin Blood type incompatibility Glucose-6-phosphate dehydrogenase (G6PD) deficiency Gestational age Previous sibling receiving phototherapy Cephalohematoma or significant bruising Exclusive breastfeeding Eastern Asian race Pathophysiology[unboundmedicine.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]
  • Pathophysiology To understand the mechanism for breast milk jaundice, it is crucial to understand newborn bilirubin metabolism and why newborns, in general, are affected by hyperbilirubinemia.[ncbi.nlm.nih.gov]
  • ., 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 Diagnostics[amboss.com]

Prevention

  • 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]
  • Prevention Breast milk jaundice cannot be prevented. When the condition occurs and the baby is a yellow color, it is very important to have the babys bilirubin level checked right away.[indiatoday.in]
  • Prevention Keys to deterrence and prevention of breast milk jaundice (BMJ) include the following: Poor caloric intake associated with insufficient breastfeeding contributes to the development of severe breast milk jaundice.[emedicine.medscape.com]

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