Pediatr. praxi. 2023;24(5):313-315 | DOI: 10.36290/ped.2023.079

Breast milk jaundice

MUDr. Nabil El-Lababidi
Centrum dětské gastroenterologie, hepatologie a výživy, Klinika pediatrie a dědičných poruch metabolismu (KPDPM) VFN a 1. LF UK, Praha

Breast milk jaundice is a relatively common, benign condition, which is present in 20-30 % of exclusively or predominantly breast-fed infants. This type of jaundice usually manifests between the first and second week of life of the newborn and remains until the 8th-12th week of age. Its aetiology is not yet fully understood. The presence of factors affecting bilirubin metabolism in the breast milk is considered. Up to 70 % of infants have a genetic mutation in UGT1A1*6. It seems that alterations of gut microbiota composition and its metabolites may affect the enterohepatic bilirubin circulation. The diagnosis of breast milk jaundice is based on exclusion of other causes of unconjugated hyperbilirubinemia. Should the total bilirubin level not fulfil phototherapy criteria, then no other intervention is required. However, clinical observation is recommended.

Keywords: breastfeeding, breast milk jaundice, bilirubin, genetic mutation UGT1A1*6, microbiota.

Accepted: October 9, 2023; Published: October 13, 2023  Show citation

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El-Lababidi N. Breast milk jaundice. Pediatr. praxi. 2023;24(5):313-315. doi: 10.36290/ped.2023.079.
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    References

    1. World Health Organization. Global strategy for infant and young child feeding. Geneva (Switzerland): WHO; 2003.
    2. Agostoni C, Decsi T, Fewtrell M, et al. Complementary feeding: a commentary by the ESPGHAN Committee on Nutrition. J Pediatr Gastroenterol Nutr. 2008;46(1):99-110. Go to original source... Go to PubMed...
    3. Gartner LM, Morton J, Lawrence RA, et al. Breastfeeding and the use of human milk. Pediatrics. 2005;115(2):496-506. Go to original source... Go to PubMed...
    4. Gao C, Guo Y, Huang M, et al. Breast Milk Constituents and the Development of Breast Milk Jaundice in Neonates: A Systematic Review. Nutrients. 2023;15(10):2261. Go to original source... Go to PubMed...
    5. Ullah S, Rahman K, Hedayati M. Hyperbilirubinemia in Neonates: Types, Causes, Clinical Examinations, Preventive Measures and Treatments: A Narrative Review Article. Iran J Public Health. 2016;45(5):558-568.
    6. Newman AJ, Gross S. Hyperbilirubinemia in breast-fed infants. Pediatrics. 1963;32:998-1001. Go to original source...
    7. Preer GL, Philipp BL. Understanding and managing breast milk jaundice. Arch Dis Child Fetal Neonatal Ed. 2011;96(6):F461-F466. Go to original source... Go to PubMed...
    8. Arias IM, Gartner LM, Seifter S, et al. 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. J Clin Invest. 1964;43(11):2037-2047. Go to original source... Go to PubMed...
    9. Bratton S, Cantu RM, Stern M. Breast Milk Jaundice. StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023.
    10. Maisels MJ, Clune S, Coleman K, et al. The natural history of jaundice in predominantly breastfed infants. Pediatrics. 2014;134(2):e340-e345. Go to original source... Go to PubMed...
    11. Setia S, Villavaces A, DhillonP, et al. Neonatal jaundice in Asian, white, and mixed-race infants. Arch Pediatr Adolesc Med. 2002;156(3):276-279. Go to original source... Go to PubMed...
    12. Huang H, Huang J, Huang W, et al. Breast milk jaundice affects breastfeeding: From the perspective of intestinal flora and SCFAs-GPR41/43. Front Nutr. 2023;10:1121213. Go to original source... Go to PubMed...
    13. Hargreaves T, Piper RF. Breast milk jaundice. Effect of inhibitory breast milk and 3 alpha, 20 abeta-pregnanediol on glucuronyl transferase. Arch Dis. Child. 1971;46(246):195-198. Go to original source... Go to PubMed...
    14. Arias IM, Gartner LM. Production of unconjugated hyperbilirubinemia in full-term new-born infants following administration of pregnane-3(alpha),20(beta)-Diol. Nature. 1964;203:1292-1293. Go to original source... Go to PubMed...
    15. Severi F, Rondini G, Zaverio S, et al. Prolonged neonatal hyperbilirubinemia and pregnane-3(alpha),20(beta)-diol in maternal milk. Helv Paediatr Acta. 1970;25(5):17-21.
    16. Foliot A, Ploussard JP, Housset E, et al. Breast milk jaundice: in vitro inhibition of rat liver bilirubin-uridine diphosphate glucuronyltransferase activity and Z protein-bromosulophthalein binding by human breast milk. Pediatr Res. 1976;10(6):594-598. Go to original source... Go to PubMed...
    17. Bevan BR, Holton JB. Inhibition of bilirubin conjugation in rat liver slices by free fatty acids, with relevance to the problem of breast milk jaundice. Clin Chim Acta. 1972;41:101-107. Go to original source... Go to PubMed...
    18. Shibuya A, Itoh T, Tukey RH, et al. Impact of fatty acids on human UDP-glucuronosyltransferase 1A1 activity and its expression in neonatal hyperbilirubinemia. Sci Rep. 2013;3:2903. Go to original source... Go to PubMed...
    19. Gao C, Miller J, Middleton PF, et al. Changes to breast milk fatty acid composition during storage, handling and processing: A systematic review. Prostaglandins Leukot Essent Fatty Acids. 2019;146:1-10. Go to original source... Go to PubMed...
    20. Ince Z, Coban A, Peker I, et al. Breast milk beta-glucuronidase and prolonged jaundice in neonates. Acta Pediatr. 1995;84(3):237-239. Go to original source... Go to PubMed...
    21. Yiğit S, Ciliv G, Aygün C, et al. Breast milk beta-glucuronidase levels in hyperbilirubinemia. Turk J Pediatr. 2001;43(2):118-120.
    22. Kumrai A, Ozkan H, Duman N, et al. Breast milk jaundice correlates with high levels of epidermal growth factor. Pediatr Res. 2009;66(2):218-221. Go to original source... Go to PubMed...
    23. Fujiwara R, Chen S, Karin M, et al. Reduced expression of UGT1A1 in intestines of humanized UGT1 mice via inactivation of NF-κB leads to hyperbilirubinemia. Gastroenterology. 2012;142(1):109-118.e2. Go to original source... Go to PubMed...
    24. Chen S, Tukey RH. Humanized UGT1 Mice, Regulation of UGT1A1, and the Role of Intestinal Tract in Neonatal Hyperbilirubinemia and Breast Milk-Induced Jaundice. Drug Metab Dispos. 2018;46(11):1745-1755. Go to original source... Go to PubMed...
    25. Maruo Y, Morioka Y, Fujito H, et al. Bilirubin uridine diphosphate-glucuronosyltransferase variation is a genetic basis of breast milk jaundice. J Pediatr. 2014;165(1):36-41.e1. Go to original source... Go to PubMed...
    26. Vítek L, Majer F, Muchová L, et al. Identification of bilirubin reduction products formed by Clostridium perfringens isolated from human neonatal. Fecal flora. J Chromatogr B Analyt Technol Biomed Life Sci. 2006;833(2):149-157. Go to original source... Go to PubMed...
    27. Li Y, Shen N, Li J, et al. Changes in intestinal Flora and Metabolites in Neonates With Breast Milk Jaundice. Front Pediatr. 2020;8:177. Go to original source... Go to PubMed...
    28. Duan M, Yu J, Feng J, et al. 16S Ribosomal RNA-based Gut Microbiome Composition Analysis in Infants with Breast Milk Jaundice. Open Life Sci. 2018;13:208-216. Go to original source... Go to PubMed...
    29. Chen K, Yuan T. The role of microbiota in neonatal hyperbilirubinemia. Am J Transl Res. 2020;12(11):7459-7474.
    30. Novák P, Jackson AO, Zhao G-J, et al. Bilirubin in metabolic syndrome and associated inflammatory diseases: New Perspectives. Life Sci. 2020;257:118032. Go to original source... Go to PubMed...
    31. American Academy of Pediatrics Subcommittee on Hyper­bilirubinemia. Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation. Pediatrics. 2004;114(1):297-316. Go to original source... Go to PubMed...

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