breast milk jaundice

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Related to Breast-feeding Jaundice: biliary atresia, physiological jaundice

jaundice

 [jawn´dis]
yellowness of skin, sclerae, mucous membranes, and excretions due to hyperbilirubinemia and deposition of bile pigments. It is usually first noticeable in the eyes, although it may come on so gradually that it is not immediately noticed by those in daily contact with the jaundiced person. Called also icterus.

Jaundice is not a disease; it is a symptom of a number of different diseases and disorders of the liver and gallbladder and of hemolytic blood disorders. One such disorder is the presence of a gallstone in the common bile duct, which carries bile from the liver to the intestine. This may obstruct the flow of bile, causing it to accumulate and enter the bloodstream. The obstruction of bile flow may cause bile to enter the urine, making it dark in color, and also decrease the bile in the stool, making it light and clay-colored. This condition requires surgery to remove the gallstone before it causes serious liver injury.

The pigment causing jaundice is called bilirubin. It is derived from hemoglobin that is released when erythrocytes are hemolyzed and therefore is constantly being formed and introduced into the blood as worn-out or defective erythrocytes are destroyed by the body. Normally the liver cells absorb the bilirubin and secrete it along with other bile constituents. If the liver is diseased, or if the flow of bile is obstructed, or if destruction of erythrocytes is excessive, the bilirubin accumulates in the blood and eventually will produce jaundice. Determination of the level of bilirubin in the blood is of value in detecting elevated bilirubin levels at the earliest stages before jaundice appears, when liver disease or hemolytic anemia is suspected.
Patient Care. Assessment of the patient with jaundice includes observations of the degree and location of yellowing, noting the color of urine and stools, and the presence of itching. Since jaundice can be accompanied by severe itching, frequent skin care is important to preserve skin integrity. Tepid sponge baths can help reduce discomfort and promote rest.

Patients with severe jaundice are at risk for encephalopathic changes that produce confusion, impaired mentation, and altered levels of consciousness. The potential for injury is increased and demands vigilance and safety measures to protect the patient.
Jaundice may be attributable to prehepatic (A), hepatic (B), or posthepatic (C) causes. From Damjanov, 2000.
acholuric jaundice jaundice without bilirubinemia, associated with elevated unconjugated bilirubin that is not excreted by the kidney. Familial acholuric jaundice is another name for the hereditary form of hemolytic jaundice.
breast milk jaundice elevated unconjugated bilirubin in some breast-fed infants due to the presence of an abnormal pregnane that inhibits glucuronyl transferase conjugating activity.
cholestatic jaundice that resulting from abnormality of bile flow in the liver.
familial nonhemolytic jaundice Gilbert disease.
hematogenous jaundice hemolytic jaundice.
hemolytic jaundice see hemolytic jaundice.
hepatocellular jaundice jaundice caused by injury to or disease of the liver cells.
leptospiral jaundice Weil's syndrome.
neonatal jaundice (jaundice of the newborn) icterus neonatorum.
nonhemolytic jaundice that due to an abnor-mality in bilirubin metabolism.
obstructive jaundice that due to blockage of the flow of bile.
physiologic jaundice mild icterus neonatorum during the first few days after birth.

breast milk jaundice

jaundice and hyperbilirubinemia in breastfed infants that occur in the first weeks of life as a result of a metabolite in the mother's milk that inhibits the infant's ability to conjugate bilirubin to glucuronide for excretion. See also hyperbilirubinemia of the newborn.
observations Breast milk jaundice usually peaks around the tenth day of life. Serum bilirubin levels usually exceed 5 mg/100 mL but rarely reach dangerous levels of 20 mg/100 mL, at which point kernicterus may develop. The infant seems normal and healthy, but the skin, the whites of the eyes, and the serum are jaundiced (yellow).
interventions If serum bilirubin exceeds acceptable levels, breastfeeding should continue frequently to enhance stooling and decrease the chance for enterohepatic circulation. Phototherapy may be used to accelerate excretion of bilirubin through the skin. The use of oral supplementation with glucose water or water alone is not recommended.
nursing considerations The primary concerns of the nurse are to observe for signs of increasing jaundice, to monitor serum bilirubin levels, and usually to reassure the mother that her child is well and that the jaundice resolves slowly but completely in time.
Jaundice in the neonatal period present to some degree in most newborns, caused by increased bilirubin, attributed to enterohepatic cycling of bile pigments, immaturity of the liver’s metabolic machinery and destruction of foetal red blood cells in the newborn. It usually appears between the 2nd and 5th days of life and clears by 2 weeks

breast milk jaundice

Neonatology Jaundice caused by an ↑ in BR in the late postnatal period, attributed to enterohepatic cycling of bile pigments See Breast feeding.