breast milk jaundice
Introduction
Introduction to breast milk jaundice Breast-fed infants develop jaundice 4 to 7 days after birth, peaking at 2 to 4 weeks (serum bilirubin can exceed 256.6-342.0 mol/L), generally in good condition without hemolysis or anemia, jaundice generally lasts 3~ 4 weeks, the second month gradually subsided, a few can be extended to 10 weeks before retreating, if the breast milk is stopped for 3 to 4 days during the jaundice, the jaundice is obviously reduced, the bilirubin is reduced by 50%, if breastfeeding is used again, jaundice does not It must reappear, even if it does not reach the original level, with the increase in breastfeeding rate, the incidence of breast milk jaundice has increased year by year, currently reaching 20% to 30%. It has also become one of the main reasons for the high incidence of hospitalized neonates. Although the prognosis of this disease is good, it requires serious treatment, but it should also be paid attention to in order to promote breastfeeding smoothly. basic knowledge The proportion of illness: 0.001% Susceptible people: infants and young children Mode of infection: non-infectious Complications: neonatal bilirubin encephalopathy bulging acute yellow
Cause
Breast milk jaundice
Increased intestinal-hepatic circulation (30%):
The reason for its occurrence is currently believed to be mainly due to the increase in the intestinal-hepatic circulation of neonatal bilirubin metabolism, which is caused by breast milk itself. The main reasons are:
1. Breast milk contains pregnant 3-20 diol. The mother's breast milk of mothers with breast milk jaundice contains pregnant 3-20 diol, which inhibits the activity of hepatic glucuronyltransferase.
2. The content of unsaturated fatty acids in breast milk is high. The content of unsaturated free fatty acids in the mother's milk of mothers with breast milk jaundice is increased, and the inhibition of hepatic glucuronyltransferase is inhibited.
3, the activity of -glucuronidase in breast milk is high, the activity of -glucuronidase in breast milk is much higher than that of milk and formula, so that the combined bilirubin is decomposed again, and the reabsorption of small intestine increases. The intestinal-hepatic circulation is increased, and -glucuronidase plays a major role therein.
Intestinal flora (25%):
In recent years, studies have shown that breast milk jaundice is caused by an increase in bilirubin intestinal-hepatic circulation under a variety of factors. This theory is more mature and proven, -glucuronidase (-GD) ) plays a major role in the pathogenesis.
1. The -GD is abundant in the intestine of the newborn. The main source of -GD in the intestine is breast milk (the newborn can also be produced by itself, but it can also be produced after the establishment of the normal intestinal flora, but less is produced), and -GD is decomposed and combined. Bilirubin, reduced to unconjugated bilirubin, reabsorbed into the intestinal-hepatic circulation through the small intestine, causing the serum to bind to bilirubin to increase, causing jaundice.
2, intestinal -GD activity is high, -GD activity in neonatal small intestine is high, 10 times that of adults.
3, less bilirubin excretion, insufficient intake of newborns, decreased intestinal peristalsis or delay in opening milk, late establishment of intestinal flora, lack of bacteria that convert bilirubin, can reduce the excretion of combined bilirubin.
4, bilirubin reabsorption, it is found that there are special fatty acids in the breast milk, cholesterol, promote the reabsorption of unbound bilirubin.
Prevention
Breast milk jaundice prevention
Some studies have suggested that increasing the intake of milk in early neonates can increase the body's calories, reduce glucuronidase activity, promote bowel movements, prevent meconium from draining as soon as possible, reduce bilirubin enterohepatic circulation, and reduce Serum bilirubin level, which reduces the prevalence of pathological jaundice in neonates, and enables newborns to obtain nutrient-rich colostrum in a timely manner, and closely monitor and strengthen follow-up of breast milk jaundice in healthy newborns, especially after birth. 2 to 3 days, the newborns of breast milk and jaundice who are discharged home will need to establish necessary follow-up so as to prevent early brain damage.
Complication
Breast milk jaundice complications Complications neonatal bilirubin encephalopathy bulging acute yellow
Breast milk jaundice refers to idiopathic jaundice associated with breastfeeding. Unbound bilirubin is potentially toxic to the central nervous system. Improper handling can cause mental, hearing, and nervous damage and cause permanent sequelae. Astragalus obviously needs to suspend breast milk. Yin yellow, if the yang gradually recovers, the jaundice gradually retreats, the prognosis is better; if the yin and yellow are cured for a long time, the heat and stagnation of the yin and blood, the jaundice deepens, and the bloating is severe, the prognosis is poor; the acute yellow death rate is high, if there is liver When kidney yang is exhausted, the prognosis is extremely poor. In addition, it can also cause bilirubin encephalopathy.
Symptom
Breast milk jaundice symptoms Common symptoms Newborn breastfeeding... Elevated bilirubin
It is characterized by jaundice soon after breastfeeding, which lasts for several weeks to several months, while other aspects are normal, divided into early-onset (breastfeeding jaundice) and late-onset (breast jaundice), early onset and neonatal physiology The appearance time of jaundice and the peak time are similar, but the highest value of breast milk jaundice exceeds physiological jaundice; the delayed type is often after physiological jaundice; jaundice gradually becomes obvious, that is, breast milk jaundice is often born. After 7 to 14 days, whether it is early or delayed breast-feeding jaundice, jaundice will decrease after 3 to 5 days of breastfeeding. If breastfeeding begins, most of the jaundice will no longer appear, and a few jaundice will reappear. With the increase of the age of the moon, the jaundice can gradually subside, with the following characteristics:
1, jaundice does not subside, during the physiological jaundice, that is, 2 days to 2 weeks after birth, but does not disappear with the disappearance of physiological jaundice.
2, the degree of jaundice is light, moderate ( 342mol / L), severely rare, with unconjugated bilirubin increased.
3, the general situation is good, the baby is completely healthy except for jaundice, good milk, normal bowel movements, satisfactory weight gain, liver and spleen is not large, liver function is normal, HBsAg negative.
4, after stopping breast milk, jaundice quickly subsided, after stopping breast milk for 48 ~ 72h, jaundice was significantly reduced, bilirubin rapidly decreased to about 50% of the original level, re-lacking, serum bilirubin will rise 17.1 ~ 51.3mol in 1-2 days /L (1 ~ 3mg / dl), and then slowly decline after a period of time, non-stop breast bilirubin will also drop to normal.
Examine
Breast milk jaundice examination
1, three major routines, three routine examinations are normal, no anemia, white blood cell count is not high.
2, blood biochemical examination, serum bilirubin mostly <257mol / L (15mg / dl), can also be > 342mol / L (20mg / dl), indirect bilirubin increased, liver function tests normal, HBsAg negative.
Generally, no special inspection is required. If necessary, chest X-rays, B-ultrasound, etc. can be found, and no abnormalities are found.
Diagnosis
Diagnosis and identification of breast milk jaundice
diagnosis
1, the exclusion of pathological jaundice, the lack of special laboratory testing methods to confirm the diagnosis of breast milk jaundice, mainly with exclusion, first rule out pathological jaundice caused by various causes, such as maternal and child ABO blood group incompatibility, sepsis, asphyxia, congenital Diseases such as hypothyroidism, galactosemia, and hereditary glucuronidase deficiency are excluded.
2, with the characteristics of breast milk jaundice, jaundice appeared in 3 to 8 days, and is mild, moderate jaundice, jaundice quickly subsided after stopping breastfeeding, and some children after breastfeeding are helpful for diagnosis.
Differential diagnosis
1, early onset high unconjugated bilirubinemia
Head hematoma and other subcutaneous hemorrhage: At this time, red blood cells are destroyed, bilirubin is increased and hyperbilirubinemia occurs. The larger the head hematoma, the more subcutaneous hemorrhage, the heavier the jaundice, and the longer the duration, according to what you see. Hematoma and the like can be distinguished from breast milk jaundice, and if the two overlap, the jaundice is heavier.
Drug-induced jaundice: oxytocin induction of labor is a common cause of high gallbladder, the general dosage of 2. 5U or more has the risk of promoting gallbladder, and the mother with diazepam, promethazine, neonatal chloral hydrate can make Unbound bilirubin can be differentiated according to the history of phase application and breast milk jaundice.
Galactosemia: an autosomal recessive disorder, mainly caused by a decrease in galactose concentration caused by galactose-1-phosphate uridine transferase deficiency. The clinical manifestation is that jaundice occurs 2 to 3 days after birth. Hair is similar to breast milk jaundice, but after 4 to 6 days, hepatosplenomegaly is often accompanied by vomiting, diarrhea, poor mental health, weight loss or decrease. If you do not stop feeding, your condition will rapidly increase and merge with infection, and you will have liver. Kidney damage, cataract, low intelligence, the disease can be diagnosed by screening or urine reducing sugar test or enzyme activity test, it is not difficult to identify with breast milk jaundice, ABO blood group is incompatible. Astragalus can occur within 24 hours after birth, but most of them will increase rapidly after 2 to 3 days of birth, peak at 4 to 6 days, and serum bilirubin can exceed 34 mol/L (20 mg/dL). Nuclear jaundice may occur. The disease mainly occurs in pregnant women with type O blood, fetal type A or type B blood, laboratory blood type immune antibodies in three tests or only release test positive can be diagnosed.
Erythrocyte glucose-6-phosphate dehydrogenase (G-6-PD) deficiency disease: high incidence in southern China, family history, laboratory examination of red blood cell morphology and reticulocyte abnormalities, G-6D PD measured low Can be diagnosed.
Neonatal sepsis: The symptoms of this disease are not characteristic, the common mentality is poor, the milk is poor or refuses to eat, the jaundice is aggravated, etc. When the jaundice is the only performance, it needs to be differentiated from breast milk jaundice, the time and peak time of neonatal sepsis jaundice and Related to the development of infectious diseases, generally have symptoms of infection, 7 days of onset, history may have premature rupture of membranes, amniotic fluid odor, fetal distress, maternal history or neonatal local infection history, 7 days after the onset, It may delay the regression of physiological jaundice or reappear after jaundice subsides. If there are signs of prodromal infection such as pneumonia or other infections accompanied by symptoms, the laboratory should first be considered for sepsis, such as white blood cell count and classification. Increase or significantly reduce the diagnosis of sepsis, blood culture local infections secretion culture and smear to find bacteria, you can diagnose and treat.
2, delayed jaundice (or persistent jaundice)
Neonatal hepatitis: Most of the virus is transmitted to the fetus through the placenta or infected through the birth canal. Hepatitis, cytomegalovirus is common, others such as rubella, herpes simplex, coxsackie virus and toxoplasma, syphilis, etc., should also be alert to blood transfusion or Hepatitis is caused by blood products. Hepatitis is usually slow and hidden. He often sees jaundice several days after birth or 3 to 4 weeks. He is persistently aggravated or relapses after physiological jaundice subsides and differentiates from breast milk jaundice. Difficulties, but often accompanied by vomiting, anorexia, weight does not increase or decrease, jaundice when the skin is dark and dark yellow, stool light or gray, dark urine, liver light or moderate swelling, liver function tests Significant changes can be identified. In mild cases, serological tests or virus isolation and differentiation of breast milk jaundice are required.
Bile sticky syndrome: severe hemolytic disease of the newborn. After a large amount of hemolysis, the common bile duct is caused by mucus or concentrated cholestasis. The combined bilirubin is increased and the jaundice is not retreated. When the stool color is light or gray, the urine is orange and breast milk. Sexual jaundice is easy to identify, but sometimes jaundice is not too serious, and there is no change in urine color, it is not easy to identify with breast milk jaundice. At this time, a small dose of prednisone can be used for 3 days. If the yellow biliary disappears obviously, it indicates that the sputum juice is deposited.
Hypothyroidism: This disease has no specific clinical manifestations in the neonatal period. Some children have low muscle tone, slow bowel movements and prolonged discharge of the first fetus, and even constipation affects the discharge of feces. Increased bilirubin liver and intestinal circulation and increased physiological jaundice, coupled with delayed maturity of liver glucuronyltransferase, prolonged the duration of physiological jaundice, similar to breast milk jaundice, so the duration of physiological jaundice is prolonged. Regardless of the accompanying symptoms, a functional examination of the adenoid should be performed in areas where no low screening is performed to confirm the diagnosis.
