Hanyang Med Rev.  2010 Feb;30(1):17-23. 10.7599/hmr.2010.30.1.17.

Breast Feeding and Jaundice

• Choi YY

• KMID: 2053729
• DOI: http://doi.org/10.7599/hmr.2010.30.1.17

Abstract

Even though there is a strong link between breast feeding and jaundice, it is natural and it may have a partially beneficial role in the neonate. There are two types of jaundice associated with breast feeding. First, insufficient caloric intake during the first week of life may increase serum unconjugated bilirubin concentration, which is known as "breast feeding jaundice (BFJ)". This increased severity of physiologic jaundice results from the increased enterohepatic circulation (EHC) of bilirubin, but not because of a factor in breast milk. Second, prolongation of unconjugated hyperbilirubinemia into the third and later weeks of life in the healthy newborn is a regularly occurring extension of physiologic jaundice, which is known as "breast milk jaundice (BMJ)". This is caused by a factor in breast milk inhibits the glucuronyl transferase in the liver and/or increases the EHC of bilirubin. The acceptable bilirubin level in the full-term healthy breast-fed infant needs to be discussed not only to prevent unnecessary interruption of breast feeding, but also to prevent kernicterus. Optimal breast feeding practices are crucial to prevent the BFJ and to minimize the intensity of BMJ. Further research is needed to clarify the benefit of bilirubin in relation to adaptation of extrauterine life.

Keyword

Breast feeding; Neonate; Unconjugated hyperbilirubinemia; Enterohepatic circulation

MeSH Terms

Aluminum Hydroxide
Bilirubin
Breast
Breast Feeding
Carbonates
Energy Intake
Enterohepatic Circulation
Humans
Hyperbilirubinemia
Infant
Infant, Newborn
Jaundice
Kernicterus
Liver
Milk
Milk, Human
Transferases
Aluminum Hydroxide
Bilirubin
Carbonates
Transferases

Reference

1. Piazza AJ, Stoll BJ. Kliegman RM, Behrman RE, Jenson HB, Stanton BF, editors. Jaundice and hyperbilirubinemia in the newborn. Nelson textbook of pediatrics. 2007. 18th ed. Philadelphia, USA: WB Saunders;756–766.

2. Maisels MJ, Newman TB. Kernicterus in otherwise healthy, breastfed term newborns. Pediatrics. 1995. 96:730–733.

3. Johnson L, Bhutani VK, Brown AK. System-based approach to management of neonatal jaundice and prevention of kernicterus. J Pediatr. 2002. 140:396–403.

4. Bhutani VK, Johnson LH, Shapiro SM. Kernicterus in sick and preterm infants (1999-2002): a need for an effective preventive approach. Semm Perinatol. 2004. 28:319–325.

5. Gartner LM. Breastfeeding and jaundice. J Perinatol. 2001. 21:Suppl 1. S25–S29.

6. Yoon YH, Choi KE, Kim KA, Ko SY, Lee YK, Shin SM. Incidence of breast milk jaundice in healthy full-term infants. Korean J Pediatr. 2007. 50:1072–1077.

7. Stevenson DK, Bartoletti AL, Ostrander CR, Johnson JD. Pulmonary excretion of carbon monoxide in human infant as an index of bilirubin production: IV. Effects of breastfeeding and caloric intake in the first postnatal week. Pediatrics. 1980. 65:1170–1172.

8. Demirkol M, Bohles H. Hixtable R, Michalk DV, editors. Breast milk taurine and its possible influence on the development of breast milk induced jaundice of the neonate-a hypothesis. Taurine in Health and Disease. 1994. New York, USA: Plenum;405–410.

9. Gartner LM, Lee KS, Vaisman S, Lane D, Zarafu I. Development of bilirubin transport and metabolism in the newborn rhesus monkey. J Pediatr. 1977. 90:513–531.

10. Weisman LE, Merenstein GB, Digirol M, Collins J, Frank G, Hudgins C. The effect of early meconium evacuation on early-onset hyperbilirubinemia. Am J Dis Child. 1983. 137:666–668.

11. Righard L, Alade MO. Sucking technique and its effect on success of breastfeeding. Birth. 1992. 19:185–189.

12. American Academy of Pediatrics, Work Group on Breastfeeding. Breastfeeding and the use of human milk. Pediatrics. 1997. 100:1035–1039.

13. Maisels J, Gifford K. Normal serum bilirubin levels in the newborn and the effect of breast-feeding. Pediatrics. 1986. 78:837–843.

14. Rubaltelli FF. Unconjugated and conjugated bilirubin pigments during perinatal development: IV. The influence of breast-feeding on neonatal hyperbilirubinemia. Biol Neonate. 1993. 64:104–109.

15. De Carvalho M, Klaus MH, Merkatz RB. Frequency of breast-feeding and serum bilirubin concentration. Am J Dis Child. 1982. 136:737–738.

16. Yamauchi Y, Ymanouchi H. The relationship between rooming-in/not rooming-in and breast-feeding variables. Acta Paediatr Scand. 1990. 79:1017–1022.

17. Kuhr M, Paneth N. Feeding practices and early neonatal jaundice. J Pediatr Gastroenterol Nutr. 1982. 1:485–488.

18. American Academy of Pediatrics, Work Group on Breastfeeding. Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation. Pediatrics. 2004. 114:297–316.

19. Arias IM, Gartner LM, Seifter S, Furman M. 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. 43:2037–2047.

20. Newman AJ, Gross S. Hyperbilirubinemia in breast-fed infants. Pediatrics. 1963. 32:995–1001.

21. Gartner LM, Lee KS, Vaisman S, Lane D, Zarafu I. Development of bilirubin transport and metabolism in the newborn rhesus monkey. J Pediatr. 1977. 90:513–531.

22. Winfield CR, MacFaul R. Clinical study of prolonged jaundice in breast- and bottle-fed babies. Arch Dis Child. 1978. 53:506–507.

23. Alonso EM, Whitington PF, Whitington SH, Rivard WA, Given G. Enterohepatic circulation of nonconjugated bilirubin in rats fed with human milk. J Pediatr. 1991. 118:425–430.

24. Gartner LM, Arias IM. Studies of prolonged neonatal jaundice in the breast-fed infant. J Pediatr. 1966. 68:54–66.

25. Cole AP, Hargreaves T. Conjugation inhibitors and early neonatal hyperbilirubinemia. Arch Dis Child. 1972. 47:415–418.

26. Luzeau R, Odievre M, Levillain P, Lemonnier A. Lipoprotein lipase activity in human milk; inhibition in vitro of the glucuronoconjugation of bilirubin. Clin Chim Acta. 1975. 59:133–138.

27. Maruo Y, Nishizawa K, Sato H, Sawa H, Shimada M. Prolonged unconjugated hyperbilirubinemia associated with breast milk and mutations of the bilirubin uridine diphosphate-glucuronyosyltransferase gene. Pediatrics. 2000. 106:E59.

28. American Academy of Pediatrics, Provisional Committee for Quality Improvement and Subcommittee on Hyperbilirubinemia. Practice parameter: management of hyperbilirubinemia in the healthy term newborn. Pediatrics. 1994. 94:558–565.

29. Gourley GR, Arend RA. β-Glucuronidase and hyperbilirubinemia in breast-fed and formula-fed babies. Lancet. 1986. 1:644–646.

30. Gartner LM, Lee KS, Moscioni AD. Effect of milk feeding on intestinal bilirubin absorption in the rat. J Pediatr. 1983. 103:464–471.

31. Kreamer BL, Siegel FL, Gourley GR. A novel inhibitor of β-glucuronidase: L-aspartic acid. Pediatr Res. 2001. 50:460–466.

32. Schanler RJ. The use of human milk for premature infants. Pediatr Clin North Am. 2001. 48:207–219.