Difference between breast milk jaundice and breast-feeding jaundice: literature review

Evidence shows that the different etiologies of neonatal jaundice, including breastfeeding and breast milk jaundice, have many different aspects. Therefore, the present study aims to conduct a literature review to compare breastfeeding and breast milk jaundice, ehich will furtherly help physicians and healthcare practitioners to have adequate information to properly establish an accurate diagnosis. The precise cause of breast milk jaundice is unclear. The majority of the suggested etiologies include factors found in human breast milk. Other theories point to possible genetic defects in the infected neonates. It has been reported that pregnane-3a,20ß-diol, epidermal growth factor, interleukin (IL)1ß, alpha-fetoprotein, and ß-glucuronidase are several factors that are solid constituents of the breast milk which may attribute to the development of this jaundice. Reports showed that breast milk jaundice usually develops in 20-30% of U.S. neonates, and most of whom are breastfed. Moreover, studies showed that more than one-third of infants on breastfeeding will eventually have high serum bilirubin levels that are ≥5 mg/dl. Evidence showed that the diagnosis should be considered when the levels of serum bilirubin exceed 5 mg/dl. Breast milk jaundice will usually fade away with no interventions, and in some cases, phototherapy inauguration and breast milk discontinuation might be needed. In breastfeeding jaundice, serum bilirubin levels usually peak within the first five or six days of life due to wrong or inadequate breastfeeding practices, and the management should be done by correcting these habits, while phototherapy might be applied when the bilirubin levels exceed 18-20 mg/dl.

The prevalence of prolonged jaundice due to breast milk jaundice in hospitalized newborn; a study among Iranian neonates

Introduction: Breast milk jaundice is considered as the most common cause for neonatal jaundice; however, its epidemiological aspects in some population remain unclear. Objectives: The present study aimed to assess the prevalence of breast milk jaundice and its main determinant among a group of neonates in western Iran. Patients and Methods: This cross-sectional study was conducted on 413 neonates hospitalized due to prolonged jaundice in Besat hospital in Hamadan, Iran. The study information was collected by reviewing the hospital’s recorded files. Results: In total, 413 neonates hospitalized were assessed in this study. The main reason for appearing jaundice included; 72.4% of cases of jaundice were due to breast milk, urinary tract infection in 4.2% of cases, glucose-6-phosphate dehydrogenase deficiency (G6PD) in 5.8% of cases, hypothyroidism in 1.2% of cases. Out of 299 neonates suffering from breast milk jaundice, 126 (42.1%) were male, and 173 (57.9%) were female with the overall average age of 16.68 ± 2.14 days. Jaundice appeared at less than two days of age in 29.4% of neonates, between 15 to 20 days of age in 64.9%, and more than 20 days of age in 5.7% of cases. Conclusion: Breast milk jaundice is considered as the most common reason for neonatal jaundice in our population, which affects more than two-thirds of our neonates. Additionally, the peak age of this phenomenon is between 15 and 20 days. The appearing breast milk jaundice is independent of gender, age, and birth weight or baseline total serum bilirubin level.

Exosomal microRNAs in Human Breast Milk: Potential Effect on Neonatal Breast Milk Jaundice

Background: The pathogenesis of breast milk jaundice (BMJ) remains unrevealed. While UGT1A1 gene has been extensively investigated in neonatal BMJ cases, the reason for down-regulation of UGT1A1 gene in neonatal BMJ has not been completely elucidated. In this research, the authors attempt to speculate whether there was some gene regulatory substance exist in human milk and result in BMJ, such as miRNA. This research aims to demonstrate the association between the profile of exosomal miRNA in human milk and the occurrence of neonate breast milk jaundice.Methods: A previous study conducted by Shanghai Children’s Medical Center of the Shanghai Jiao Tong University School of Medicine and the UIB International Maternity Care Center regarding 12 mother-infant dyads were recruited from September 2016 to December 2016. The subjects were divided into two groups (BMJ and control) for exosomal miRNA screening. Four methods of transmission electron microscopy (TEM), a nanoparticle tracking analyzer (NTA), flow cytometry (FCM), and Western blotting were used to identify the exosome in human milk. Based on the previous study, this research determines the expression profile of miRNA in human milk exosomes by small RNA sequencing. Based on the biological information analysis, the authors not only screen the differentially expressed miRNA but also predict the target genes. Then, another 20 mother-infant dyads were recruited for realtime PCR assay to verify the difference of predicted microRNAs expression in breast milk exosomes and to explore the correlation between differentially expressed microRNAs in breast milk and neonatal breast milk jaundice. Results: Human milk exosomes are rich in various types of microRNA, especially let-7g-5p, let-7b-5p, has-miR-21-5p, has-miR-375, has-miR-99a-5p, et al. The predicted target genes of miR-127-3p are statistically significantly overexpressed in BMJ group, including the gene of UGT1A1 which expresses key enzyme in process of bilirubin metabolism. Conclusions: Exosomal miRNA-127-3p plays a potential effect on neonatal breast milk jaundice.

Prevalence and time course of elevated serum levels of liver enzymes in otherwise healthy Thai infants with breast milk jaundice: a cohort study

BackgroundNeonatal jaundice and elevated levels of liver enzymes are found in infants with breast milk jaundice (BMJ).ObjectivesTo determine the prevalence and duration of elevated serum levels of liver enzymes in Thai infants with BMJ.MethodsWe conducted a prospective study of Thai infants with BMJ, excluding those with pathological causes of jaundice. We measured the serum levels of total bilirubin (TB), aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALP), and γ-glutamyl transferase (GGT); followed infants with elevated levels; and estimated the time for levels to become normal using Kaplan–Meier analysis.ResultsWe included 42 infants (median age: 17.5 days) with BMJ, and elevated serum levels of at least 1 enzyme were found in 27 (64%) infants. We excluded 4 (10%) infants because they did not continue to be exclusively breastfed, 17 (40%) were lost to follow-up, and 21 (50%) completed the study. We found that 19 (45%) of the 42 infants had elevated GGT, 11 (26%) had elevated ALT, and 9 (21%) each had elevated AST and ALP levels. The median time for enzyme levels to normalize was 291 days (95% confidence interval [CI], 109.8 to 472.2) for ALT, 240 days (95% CI, 139.0 to 340.9) for AST, 184 days (95% CI, 4.4 to 363.6) for ALP, 120 days (95% CI, 74.6 to 164.5) for TB, and 63 days (95% CI, 61.44 to 64.6) for GGT. Infants were otherwise healthy during the follow-up.ConclusionThe prevalence of elevated serum levels of liver enzymes in Thai infants was unexpectedly high, but the levels became normal spontaneously despite continued breastfeeding, which endorses a “watchful waiting” strategy in managing asymptomatic infants with BMJ.

HYPERBILIRUBINEMIA;

Objectives:The main objective of this study was to look at the burden of neonates, who develop hyperbilirubinemia and the cause of hyperbilirubenemia in these neonates.Setting: Neonatal Unit of Pediatric Ward of PMC Hospital, Nawabshah. Study Design:Observational study.Period:Jan 2016 to December 2016. Materials and Methods:Total 194 neonates were found to have hyperbilirubinemia, out of 2863 babies admitted during this period. Files of these neonates were taken and following data was extracted regarding total, direct and indirect bilirubin, blood groups and Rh typing. In selected cases following investigations were also done: TORCH profile, Urine D/R, Thyroid profile and Ultrasound abdomen.Result:194 babies out of 2863 admissions in neonatal unit were treated as hyperbilirubinemia. 108 babies were male and 86 were females. Regarding the gestational age, 56 babies were preterm and 138 were full term babies.Among various causes of hyperbilirubinemia, physiological jaundice was seen in 109 patients, 22 were having direct hyperbilirubinemia, 36 were due to blood group incompatibility, 15 were due to birth injuries, 4 were having hypothyroidism and 2 were labeled as breast milk jaundice. In 6 patients no single cause was pointed out.Conclusion:Hyperbilirubinemia is still a main cause for admissions in NICU, among the causes of hyperbilirubinemia physiologic jaundice was most common. Prematurity predisposes to aggravating hyperbilirubinemia and its complications.