Breast milk jaundice is called breast milk jaundice in neonatal jaundice, and jaundice may appear when the baby is born. In early prevention of breast-feeding jaundice, newborns should increase the number of feeding, but the amount should not be too much each time. The following is a content sharing about breast milk jaundice.
Causes of breast milk jaundice 1 breast milk jaundice
Breast-fed babies develop jaundice at 4 ~ 7 days after birth, reaching the peak at 2 ~ 4 weeks (serum bilirubin can exceed 256.6~342.0μmol/L/L). Generally speaking, they are in good condition without hemolysis or anemia. Jaundice usually lasts for 3 ~ 4 weeks, and gradually subsides in the second month, and a few can be delayed to 65,438+00 weeks. If breast-feeding is stopped for 3 ~ 4 days, jaundice is obviously reduced and bilirubin is reduced.
With the improvement of breastfeeding rate, the incidence of breast-feeding jaundice has increased year by year, and it has reached 20% ~ 30% at present. It has also become one of the main causes of hyperbilirubinemia in hospitalized newborns. Although only those with good prognosis need treatment, we should also pay attention to the smooth promotion of breastfeeding.
symptom
Symptoms of breast milk jaundice 1: Children are well nourished, generally in good condition, gain weight, have yellow stools and normal stools.
Symptoms 2 of breast milk jaundice: the liver and spleen are not big.
Symptoms 3 of breast milk jaundice: the child's liver function is normal and there is no anemia.
Symptoms of breast milk jaundice 4: Jaundice usually appears 4-5 days after birth and gradually gets worse. The increased bilirubin can be maintained for about 10 days, then jaundice gradually decreases and returns to normal level in 3- 12 weeks.
clinical picture
If there is no other reason for hyperbilirubinemia caused by breastfeeding after birth, bilirubin can often reach 256.5 ~ 342 μ mol/L (15 ~ 20 mg/dl). Newborns are generally in good condition, enjoying good breastfeeding and normal growth and development. Jaundice can last for 3 weeks to 3 months.
The cause of disease
Because breast milk contains more lipase and β -glucuronidase, the former increases unsaturated fatty acids in milk, thus inhibiting the activity of liver glucuronidase; The latter can decompose the ester bond of bilirubin glucuronic acid ester, so that the bound bilirubin can be converted into free bilirubin, which can be easily reabsorbed in the small intestine, thus increasing the intestinal-liver circulation, leading to the increase of free bilirubin in the blood and jaundice.
pathogenesis
The main reasons are insufficient breast milk, late lactation and delayed meconium discharge. Mainly because breast milk is rich in β glucuronidase, which forms hydrolyzable bound bilirubin through active intestinal-hepatic circulation.
diagnose
1, jaundice caused by breast milk usually appears yellow staining on skin and mucosa 4 ~ 5 days after birth, and there is no other abnormality. Jaundice is getting worse. Unbound bilirubin reached 10 ~ 15 days after birth171~ 513 umol/l. If breast-feeding is continued, the increased bilirubin can last for 4 ~ 10 days, then slowly decrease, and return to normal level in 3 ~ 12 weeks, and jaundice completely subsides. If breast-feeding is stopped, serum bilirubin can drop significantly within 48 hours.
2. Neonatal jaundice persists or lessens, and then gets worse. After stopping breastfeeding for 48 hours, bilirubin drops by 50%, and the diagnosis can be made.
3. If breastfeeding is resumed, bilirubin will increase17 ~ 51umol/L (1~ 3 mg/dl), but it will not reach the original high level.
4. In the case of normal liver function, it should be differentiated from jaundice caused by hemolysis and infection.
kind
Breast milk jaundice can generally be divided into early onset and late onset. The appearance time and peak time of early-onset jaundice are similar to that of neonatal physiological jaundice, that is, it appears 2 ~ 3 days after birth, most obvious in 4 ~ 6 days, and disappears within two weeks. But from the clinical practice, the highest value of breast milk jaundice exceeds physiological jaundice. Delayed onset often occurs immediately after delivery of rational jaundice, and may be aggravated after physiological jaundice is relieved, which means that breast-fed jaundice often occurs 7- 14 days after birth.
treat cordially
Stop breastfeeding for 3 days and change to artificial feeding. The milk quantity is calculated as150ml/kg.d. During the period of breast milk suspension, breast milk should be sucked out with a breast pump to keep the milk fully secreted, and breast feeding should be continued after jaundice subsides.
At the same time, support therapy is given: keep warm, increase calories and nutrition, and prevent infection; Encourage lactating mothers to feed a small amount of milk many times to increase the number of defecation. Severe cases were treated with drugs such as liver protection and enzyme inducer. The prognosis of breast-feeding jaundice is good, and jaundice will disappear immediately after stopping breast-feeding. So far, there is no report of bilirubin encephalopathy caused by breast milk jaundice. In order to reduce the incidence of this disease, we should encourage lactating mothers to start early, feed a small amount of milk many times, increase the number of defecation, and reduce the absorption of bilirubin in the intestine, which can reduce the incidence of jaundice. In addition, support therapy such as keeping warm, increasing calories and preventing infection should be given to children to prevent jaundice from getting worse.
Treatment of breast milk jaundice can also take oral Chen Yin Bailing Decoction as the main treatment method, supplemented by phenobarbital as western medicine. Experiments show that the total effective rate of integrated traditional Chinese and western medicine in treating breast milk jaundice is 100%. Jaundice completely subsided, and the clinical effect was good.
When hyperbilirubinemia occurs, intervention measures such as stopping breastfeeding should be taken according to the situation. Under the premise of not affecting breastfeeding as much as possible, various interventions should reduce bilirubin levels as soon as possible.
At present, the accepted intervention standard is to stop breastfeeding when the serum bilirubin is 275 ~ 425 μ mol/L (16 ~ 25mg/dl), change to formula milk for more than 2 days, and then resume breastfeeding until the bilirubin drops to a safe range of 300 ~ 375 μ mol/L (17.6 ~ 22mg/dl).
It's getting lighter, so you can continue to breastfeed. When you are heavy, you should stop breastfeeding and switch to other formulas. When the serum bilirubin of premature infants reaches 170μmol/L, breast-feeding should be stopped and phototherapy should be performed. Late-onset breast-feeding jaundice, when serum bilirubin 15mg/dl, stop breastfeeding for 3 days, and when it is more than 20mg/dl, add phototherapy, which generally does not require human albumin or plasma treatment.
prevent
Pay attention to food hygiene during pregnancy, avoid alcohol and spicy products, and do not abuse drugs. If the pregnant mother has a history of jaundice, she can take jaundice Yinzhen granules orally. It is advisable to take medicine for more than two months from diagnosis to delivery. After the baby is born, it is advisable to closely observe the situation of skin jaundice for timely diagnosis and treatment. Pay attention to the premature appearance or late regression or jaundice gradually deepening or regression and reappear, so as to break the infection in time.
Some studies believe that increasing the intake of milk in the early and early neonatal period can increase the calories of newborns and reduce the activity of glucuronidase. It can promote intestinal peristalsis and make meconium be discharged as soon as possible. Reduce bilirubin intestinal and liver circulation, reduce serum bilirubin level, thus reducing the prevalence of neonatal pathological jaundice. Can make the newborn get nutritious colostrum in time. Close monitoring and follow-up should be strengthened for healthy newborns with breast milk jaundice, especially for newborns with breast milk jaundice discharged from hospital 2 ~ 3 days after birth, necessary follow-up should be established to carry out early intervention to prevent brain damage.
Causes of breast-feeding jaundice 2 Breast-feeding jaundice means that breast-fed babies still have jaundice within three months after birth. Studies have shown that some mothers have relatively high levels of β -glucuronidase in their breast milk. By increasing the separation of intestinal glucuronic acid and bilirubin in the intestine, unbound bilirubin is reabsorbed by the intestine, thus increasing the burden of liver in dealing with bilirubin. Therefore, breastfeeding babies may cause jaundice to last for too long.
Breast milk jaundice generally does not require special treatment. If breast-feeding is stopped for 2-3 days, the child's jaundice can be reduced by about half, and generally it will not cause bilirubin encephalopathy. The diagnosis of breast milk jaundice is exclusive. Only by excluding jaundice caused by infection, biliary tract diseases and liver diseases, as well as jaundice caused by genetic and metabolic diseases such as hypothyroidism, can breast-feeding jaundice be diagnosed. If the baby's jaundice persists, you need to go to the hospital to check and rule out the diagnosis of other diseases before you can be diagnosed as breast milk jaundice.
Neonatal jaundice after breastfeeding.
I. Clinical manifestations
It is characterized by jaundice in newborns shortly after breastfeeding, which can last for weeks to months, but it is normal in other respects. It can be divided into early onset (breast milk jaundice) and late onset (breast milk jaundice). The appearance time and peak time of early-onset and neonatal physiological jaundice are similar, but the highest value of breast milk jaundice exceeds physiological jaundice. Late-onset patients often become more and more obvious after physiological jaundice, that is to say, breast-feeding jaundice often appears 7 ~ 14 days after birth.
Whether it is early-onset or late-onset breast-feeding jaundice, once breast-feeding is stopped for 3 to 5 days, jaundice will be alleviated; If breastfeeding is resumed, most jaundice will no longer appear, and a few jaundice will reappear. With the growth of months, jaundice can gradually subside, which has the following characteristics:
1, jaundice does not return
It occurs during physiological jaundice, that is, 2 days to 2 weeks after birth, but it does not disappear with the disappearance of physiological jaundice.
2. Degree of jaundice
It is mainly mild to moderate (≥ 34,208 mol/L), and severe cases are rare, especially the increase of free bilirubin.
The overall situation is good.
Except jaundice, the baby is completely healthy, with good milk, normal urination, satisfactory weight gain, small liver and spleen, normal liver function and HBsAg negative.
4. Jaundice quickly subsided after stopping breastfeeding.
After stopping breastfeeding for 48 ~ 72h hours, jaundice was obviously reduced, and bilirubin quickly dropped to about 50% of the original level. After breast-feeding, serum bilirubin will rise within two days17.1~ 51.308mol/l (1~ 3mg/dl), and then bilirubin in breast milk will automatically drop to normal without stopping.
Second, diagnosis.
1. Exclusion of pathological jaundice At present, there is no special laboratory test method to diagnose breast milk jaundice. Exclusion method is mainly used. Firstly, we rule out pathological jaundice caused by various reasons, such as ABO blood group incompatibility between mother and baby, septicemia, asphyxia, congenital hypothyroidism, galactosemia, hereditary glucuronosyltransferase deficiency, etc.
Jaundice with the characteristics of breast milk jaundice appeared from 2.3 to 8 days, which was mild to moderate jaundice. Jaundice quickly subsided after stopping breastfeeding, and jaundice reappeared in some children after breastfeeding, which is helpful for diagnosis.
Reasons for breast milk jaundice 3 What is breast milk jaundice? In fact, breast milk jaundice can be divided into two types. The first type is commonly seen in children after birth 1 week, and all of them are exclusively breastfed newborns, commonly known as early-onset breast-feeding jaundice, also known as breast-feeding related jaundice.
The pathogenesis of this kind of breast-feeding jaundice is mainly due to the fact that children don't eat enough milk, that is, they don't consume enough energy, and the number of breastfeeding and the amount of breastfeeding are relatively small. At this time, the baby's intestinal peristalsis will be reduced, a large amount of meconium or feces will not be discharged in the baby's intestine, the intestinal and hepatic circulation will increase, and a large amount of bilirubin will be reabsorbed from the intestine and returned to the baby, resulting in severe jaundice in the baby.
In addition, there is also a late-onset breast-feeding jaundice, which is often called true breast-feeding jaundice. This kind of jaundice mostly occurs in normal newborns who are exclusively breastfed 1 week or more. The pathogenesis is that the content of β glucuronidase in breast milk is high, which can lead to the increase of bilirubin in children's intestines after reabsorption, thus leading to jaundice in children. For breast milk jaundice, most breast milk jaundice is not particularly high, so it has little effect on children.
Moreover, breast milk jaundice is caused by breast milk, so in fact, as long as breast milk is not stopped, the child may always be yellow, and this yellow has little effect on the child. Therefore, if breast milk jaundice is confirmed, there is generally no need to do special treatment, just observe and wait until the child is born 2-3 months later.
Of course, if the child's breast milk jaundice has reached a very high level, for example, it has reached more than 20-25mg/dL, at this time, the child may still be at risk of bilirubin encephalopathy, and it is necessary to actively treat the child, such as paying attention to stopping breast milk or active blue light irradiation to avoid serious complications for the child.