NEONATAL JAUDICE, BILIRUBIN, BREAST MILK JAUNDICE

neonatal jaudice, bilirubin, breast milk jaundice

Neonatal Jaudice, Bilirubin, Breast Milk Jaundice

Introduction

Breast milk jaundice is a type of newborn jaundice which is associated with breastfeeding. It is characterised by a raised level of unconjugated bilirubin (also called the indirect bilirubin) in blood. It develops after the first 4 to 7 days, lasts for about 3 to 12 weeks and has no other identifiable cause. The cause of breast milk jaundice is not found but is supposed to be due to following reasons,

presence of pregnane 3 -beta 20- alpha diol and free fatty acids in breast milk that interferes with normal metabolism of bilirubin.

the delay in appearance of normal gut bacteria in baby's gut, due to ingestion of breast milk- which interferes with excretion of bilirubin.

Breast milk jaundice is important because

the presence of jaundice beyond 2 weeks in term babies and 3 weeks in premature babies, should alert the doctor to look for and rule out other causes of jaundice by examining the baby, testing for a split bilirubin test and if necessary performing other tests.

when other conditions are ruled out, it is important to reassure the parents about the harmless nature of breast milk jaundice and prepare them for the lengthy period that the baby could remain jaundiced (up to 3 months).

What is bilirubin?

A newborn is born with an excess of red blood cells that has to be broken up and removed from his blood.These red blood cells have a shorter life span that those of adult's. Bilirubin is one such waste product of broken up red blood cells. The bilirubin that reaches liver is called unconjugated bilirubin. In the liver, bilirubin is conjugated with a sugar to form conjugated bilirubin. Conjugated bilirubin is soluble and it is secreted in to the gut. Here it is further broken down and excreted.

The importance of understanding the metabolism of bilirubin is that the split bilirubin test which measures the levels of conjugated and unconjugated bilirubin helps us to diagnose the cause of Jaundice. For example, jaundice due to liver disease usually causes a leakage of conjugated bilirubin in to blood which is detected by the split bilirubin test.

Also, such presence of water soluble conjugated bilirubin will turn the urine yellow, as kidneys try to excrete the metabolite. In cases of obstruction of bile flow due to liver disease or obstruction of bile ducts, the stools changes from the normal yellow color to white or putty color. This is very important to differentiate breast milk jaundice ( where babies pass plenty of colorless urine and golden yellow poo) from other serious causes of long standing jaundice (for example a liver disease where babies may pass dark yellow urine and pale poo).

Jaundice in newborn

Jaundice is the yellow appearance of eyes and skin . Jaundice is very common in newborn babies. About 90% of babies become jaundiced two or three days after birth.(Jaundice occuring in the first 24 hours after birth is abnormal and must be evaluated by a doctor)

Physiological ...