BREAST MILK JAUNDICE CAUSES LAB

breast milk jaundice causes:
• Supplementation of breastfeeding with dextrose 5% in water (D5W) actually can increase the prevalence or degree of jaundice.

• Late milk production and poor feeding lead to decreased caloric intake, dehydration, and increased enterohepatic circulation, resulting in higher serum bilirubin concentration.

• The biochemical cause of breast milk jaundice remains under investigation. Some research reported that lipoprotein lipase, found in some breast milk, produces nonesterified long-chain fatty acids, which competitively inhibit glucuronyl transferase conjugating activity.

• Glucuronidase has also been found in some breast milk, which results in jaundice.

breast milk jaundice lab studies:
• Measure total serum bilirubin in neonates who have jaundice that has progressed from the facies to the chest and in neonates at risk for hemolytic disease of the newborn.

• The following tests are to be considered if serum bilirubin is greater than 12 mg/dL (170 pmol/L). A total serum bilirubin rising faster than 5 mg/dL/d (85 pmol/L/d) or jaundice before 24 hours of life suggests pathologic jaundice.

• Fractionated serum bilirubin: A level of conjugated bilirubin greater than 2.0 mg/dL (34 pmol/L) suggests cholestasis, biliary atresia, or sepsis (see Jaundice, Neonatal).

• Complete blood count o Polycythemia (Hct >65%) o Anemia (Hct <40%) o Sepsis (WBC count <5 K/mL or >20 K/mL) with immature to total neutrophil ratio greater than 0.2 o Urine specific gravity can be useful in the assessment of hydration status.

• If hemolysis is suspected, consider the following tests:
o Blood type to evaluate for ABO and Rh incompatibility
o Coombs test to evaluate for immune mediated hemolysis
o Peripheral smear to look for abnormally shaped RBCs (ovalocytes, acanthocytes, spherocytes, schistocytes)
o G-6-PD screen if ethnicity consistent

• Factors that suggest possibility of hemolytic disease include the following:
o Family history of hemolytic disease
o Onset of jaundice before 24 hours of life
o Rise in serum bilirubin levels of more than 0.5 mg/dL/h
o Pallor, hepatosplenomegaly
o Rapid increase in serum bilirubin level after 24-48 hours (G-6-PD deficiency)
o Ethnicity suggestive of G-6-PD deficiency
o Failure of phototherapy to lower bilirubin level

• If sepsis is suspected, consider the following tests:
o Blood culture
o WBC differential
o Platelet count

• Factors that suggest the possibility of sepsis include the following:
o Poor feeding
o Vomiting
o Lethargy
o Temperature instability
o Apnea
o Tachypnea

• Signs of cholestatic jaundice that suggest the need to rule out biliary atresia or other causes of cholestasis include the following:
o Dark urine or urine positive for bilirubin
o Light-colored stools
o Persistent jaundice for more than 3 weeks