Breast-milk jaundice

Al. Adlard, B. P. F., and Lathe, G. H., Breast milk jaundice effect of 3a,20 -preg-nanediol on bilirubin conjugation by human liver. Arch. Dis. Childhood 45,186-189... 

Grunebanm, E., Amir, J., Merlob, R, Mimonni, M., Varsano, I. Breast milk jaundice natural history, famiUal incidence and late neurodevelop-mental outcome of the infant. Eur. J. Pediat. 1991 150 267 - 270... 

Benign Not evident while sole nutrition is breast milk Severe hypoglycemia and lactic acidosis after fructose ingestion Vomiting, apathy, diarrhea Liver damage and jaundice Proximal renal tubule disorder resembling Fanconi syndrome Treatment eliminate sources of fructose from diet... 

Ectopic as well as intrauterine pregnancy may occur in contraceptive failures. Lactation Hormonal contraceptives may interfere with lactation, decreasing both the quantity and the quality of breast milk. A small amount of OC steroids is excreted in breast milk. A few adverse effects on the nursing infant have been reported, including jaundice and breast enlargement. 

A woman returns from a yearlong trip abroad with her 2-week-old infant, whom she is breastfeeding. The child soon starts to exhibit lethargy, diarrhea, vomiting, jaundice, and an enlarged liver. The pediatrician prescribed a switch from breast milk to infant formula containing sucrose as the sole carbohydrate. The baby s symptoms resolve within a few days. 

Hepatonephritis and pulmonary edema were reported as causes of fetal death. The presence of PCE in breast milk was the cited reason for obstructive jaundice in a 6-week old infant (ref. 35. P 303). A study by Schwetz et al. (ref. 68) indicates that PCE may be teratogenic. Delayed skull-bone ossification and split stembrae were observed in mice, as well as increased fetal resorption, decreased fetal body weight and fetal subcutaneous edema. 

After approx. 10 days, newborn jaundice subsides without any further consequences. Bilirubin also acts as an antioxidant and can thus provide protection from oxygen radicals, if necessary. Peripartal complications can, however, reinforce or prolong this state. This may occur in infantile hypothyroidism or when medication is administered directly to the infant as well as via breast milk (particularly when bilirubin is displaced from its albumin binding by drugs). In more pronounced jaundice, phototherapy and an increase in the oral intake of fluids may be advisable. (44, 45, 48,53,58, 64)... 

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

Because the safe use of carbamazepine during pregnancy has not been established, caution should be used in prescribing carbamazepine during the first trimester of pregnancy or in women of reproductive age. Carbamazepine may cause craniofacial deformities, spina bifida (0.5% to 1%), and low birth weight. Carbamazepine is excreted in breast milk (the milk-to-maternal plasma ratio of carbamazepine is about 0.4)." There are two case reports of transient cholestatic hepatitis and jaundice in nursing infants. 

HBV and HCV are diseases of the liver, sometimes referred to as hepatitis or inflammation of the liver. Both HBV and HCV are bloodbome pathogens, like HIV. The virus is most concentrated in blood, serum, and wound exudates. The virus is also present in smaller concentrations in semen, vaginal fluid, and breast milk. Low concentrations exist in urine, feces, sweat, tears, and saliva. The incubation period for HVB is from 45 to 160 days, and for HCV 2 to 26 weeks, with a fatality rate of 1 to 1.4%. Like HIV, symptoms are insidious at onset. They include anorexia, malaise, nausea, vomiting, abdominal pain, jaundice, skin rashes, arthralgies, and arthritis. A vaccine is available for HBV. 

Hepatic Effects. The liver has not been shown to be a target organ in humans exposed to tetrachloroethylene by the oral route except a single case report of obstructive jaundice and hepatomegaly reported in a 6-week-old infant exposed to tetrachloroethylene (1 mg/dL) via breast milk (Bagnell and Ellenberger 1977). After breast feeding was ended, a rapid improvement was observed. 

In addition to breathing contaminated air, infants can also be exposed to tetrachloroethylene in breast milk. For example, tetrachloroethylene was present at unspecified levels in seven of eight samples of mother s milk from four urban areas in the United States (Pellizzari et al. 1982). A woman in Halifax, Nova Scotia, who visited her husband daily at the dry cleaning plant where he worked, was found to have tetrachloroethylene present in her breast milk (Bagnell and Ellenberger 1977). This was discovered after her breast-fed infant developed obstructive jaundice, which was attributed to the contaminant. Using a PBPK model, Schreiber (1993) predicted that for women exposed under occupational conditions, breast milk concentrations would range from 857 to 8,440 pg/L. The exposure scenario for the low concentrations was 8 hours at about 6 ppm (exposure concentration of counter workers, pressers and... 

Bagnell PC, Ellenberger HA. 1977. Obstructive jaundice due to a chlorinated hydrocarbon in breast milk. Can Med Assoc J 117 1047-1048. 

The occasonal disadvantages of breast milk are less well known. It is possible to transmit infection (e.g. HIV) as well as drugs through breast milk. Breastfeeding can cause a mild self-limiting hyperbihrubinaemia, resulting in jaundice. It can also be associated with a vitamin K deficiency as there are insufficient levels in breast milk (17b). 

---