JAUNDICE FROM BREAST MILK
Keywords:jaundice, breast milk, breastfeeding, bilirubinemia levels
Breast milk jaundice is a type of neonatal jaundice associated with breastfeeding that is characterized by indirect hyperbilirubinemia in an otherwise healthy breastfed newborn that develops after the first 4-7 days of life, persists longer than physiologic jaundice, and has no other identifiable cause. Breast milk jaundice should be differentiated from breastfeeding jaundice, which manifests in the first 3 days of life, peaks by 5-15 days of life, disappears by week 3 of life, and is caused by insufficient production or intake of breast milk.
Objective: Follow-up the dynamics of bilirubinemia in newborns with jaundice from breast milk.
Material and methods: We followed the evolution of neonatal jaundice in 423 full-term infants born in the Department of Neonatology of UMHAT Medica Ruse Ltd. for the period 2017-2020. We performed transcutaneous bilirubinometry daily from the first day until leaving the ward, as well as on the 14th and 28th postnatal day. In the prolonged forms, we continued the follow-up until the complete disappearance of jaundice, which was by the 90th postnatal day at most. The children were divided into two groups - Group A (232) exclusively breastfed and Group B (191) newborns fed with a standard formula for newborns. The treatment of neonatal jaundice is carried out only by phototherapy. We compared bilirubinemia levels and the rate of hyperbilirubinemia in the two groups.
Results: There is no significant difference in gender, gestational age and weight between groups. There was no significant difference in mean bilirubin levels from day one to day 28. No difference was found in the initial time of initiation of phototherapy and duration of hospital stay. In group A the hours of phototherapy (15.5 ± 9.6 hours) were significantly longer than in group B (13.0 ± 6.3 hours), (p = 0.025). For the whole observed period the share of newborns with hyperbilirubinemia in group A is higher than in group B, and on days 4, 5 and 14 this difference is significant. We report prolonged forms of neonatal jaundice in group A in 14.7% and in group B -12.9% as of day 28. In group A, the frequency of readmission, due to the need to treat neonatal jaundice, was significantly higher (p = 0.013).
Conclusion: In our study in breastfed infants, we reported a significant difference in the proportion of hyperbilirubinemia as well as in the duration of phototherapy. We observed neonates up to involution of neonatal jaundice, and in the prolonged forms the share of exclusively breastfed children is insignificantly higher.
Arias, I. M., Gartner, L. M., Seifter, S., & Furman, M. (1964). Prolonged neonatal unconjugated hyperbilirubinemia associated with breast feeding and a steroid, pregnane-3 (alpha), 20 (beta)-diol, in maternal milk that inhibits glucuronide formation in vitro. The Journal of clinical investigation, 43(11), 2037-2047.
Auerbach, K. G., & Gartner, L. M. (1987). Breastfeeding and Human Millk: Their Association with Jaundice in the Neonate. Clinics in perinatology, 14 (1), 89-107.
Bratton, S., Cantu, R. M., & Stern, M. (2019). Breast milk jaundice.
El-Kholy, M. S., Halim, H. Y., & Marzouk, A. H. (1992). Beta-glucuronidase and hyperbilirubinemia in breast-fed versus formula-fed babies. The Journal of the Egyptian Public Health Association, 67(3-4), 237-248.
Jones, E., Taylor, B., Rudge, G., MacArthur, C., Jyothish, D., Simkiss, D., & Cummins, C. (2018). Hospitalisation after birth of infants: cross sectional analysis of potentially avoidable admissions across England using hospital episode statistics. BMC pediatrics, 18 (1), 1-10.
Keren, R., Tremont, K., Luan, X., & Cnaan, A. (2009). Visual assessment of jaundice in term and late preterm infants. Archives of Disease in Childhood-Fetal and Neonatal Edition, 94(5), F317-F322.
Kuei-Hui, C. H. U., Sen-Wen, T. E. N. G., Chen-Jei, T. A. I., Chang, C. M., & Chien, L. Y. (2021). Does Jaundice in Newborn Infants Affect Exclusivity and Duration of Breastfeeding in Taiwan?. Journal of Nursing Research, 29 (2), e145.
Leung, A. K., & Sauve, R. S. (1989). Breastfeeding and breast milk jaundice. Journal of the Royal Society of Health, 109(6), 213-217.
Lifei, Y. A. N. G., Hu, R., Li, J., Mo, X., Xu, L., Shen, N.& Li, Y. (2020). Exosomal microRNAs in Human Breast Milk: Potential Effect on Neonatal Breast Milk Jaundice.
Maisels, M. J., Clune, S., Coleman, K., Gendelman, B., Kendall, A., McManus, S., & Smyth, M. (2014). The natural history of jaundice in predominantly breastfed infants. Pediatrics, 134(2), e340-e345.
Preer, G. L., & Philipp, B. L. (2011). Understanding and managing breast milk jaundice. Archives of Disease in Childhood-Fetal and Neonatal Edition, 96(6), F461-F466.
Schneider, A. P. (1986). Breast milk jaundice in the newborn: A real entity. Jama, 255(23), 3270-3274.
Soldi, A., Tonetto, P., Varalda, A., & Bertino, E. (2011). Neonatal jaundice and human milk. The Journal of Maternal-Fetal & Neonatal Medicine, 24(sup1), 85-87.
Ullah, S., Rahman, K., & Hedayati, M. (2016). Hyperbilirubinemia in neonates: types, causes, clinical examinations, preventive measures and treatments: a narrative review article. Iranian journal of public health, 45(5), 558.
Watchko, J. F. (2018). Neonatal indirect hyperbilirubinemia and kernicterus. In Avery's Diseases of the Newborn (pp. 1198-1218). Elsevier.