Breast milk hyperbilirubinemia

Causes of unconjugated hyperbilirubinemia in the neonate are physiological jaundice of the newborn, hemolytic disease, and breast milk hyperbilirubinemia. 

Breast Milk Hyperbilirubinemia. This type of hyperbilirubinemia affects about 30% of breast-fed newborns. It is due to a-glucuronidase in breast milk, which hydrolyzes conjugated bilirubin in the intestine. The unconjugated bilirubin, being more lipophilic, is passively absorbed. The condition lasts for a few weeks and is treated by discontinuing breast feeding. 

Lactation TMP-SMZ is not recommended in the nursing period because sulfonamides are excreted in breast milk and may cause kernicterus. Premature infants and infants with hyperbilirubinemia or G-6-PD deficiency are also at risk for adverse effects. 

AlO. Arias, I. M., Gartner, L. M., Seifter, S., and Furman, M., Prolonged neonatal unconjugated hyperbilirubinemia associated with breast feeding and a steroid, pregnane-3a,20/3-diol, in maternal milk that inhibits glucuronide formation in vitro. J. Clin. Invest. 43, 2037-2047 (1964). 

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