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Breast milk jaundice is diagnosed in a healthy infant with good weight gain
who at greater than 7 days of age is jaundiced,
has a normal direct bilirubin level
and an elevated total bilirubin level.
These babies are usually asymptomatic except for their yellow color.
They are feeding well and doing well.
Very few of them have bilirubin levels that approach 20 mg/dL
(
Gartner, 1966
).
The etiology appears to be a substance in maternal milk
(it is not yet known which substance),
that causes increased reabsorption of bilirubin from the stool
and consequently decreased excretion of bilirubin.
The differential diagnosis includes continuing hemolysis,
hypothyroidism, liver disease and congenital defects
of bilirubin conjugation (
Dixit, 1999
and
Alonso, 1991
).
A study of 17 healthy Japanese breastfed infants with prolonged
unconjugated hyperbilirubinemia found that 16 of the 17 had a
mutation of a gene associated with Gilbert's syndrome. They
hypothesized that a component of breast milk may trigger the jaundice
in infants who have this mutation. (
Maruo, 2000
).
The factors of being healthy, having good weight gain and
a normal direct bilirubin level must be present to make the diagnosis
of breast milk jaundice.
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