In a message dated 3/1/01 7:22:40 PM Eastern Standard Time,
[log in to unmask] writes:


>
> One of my clients has called wanting more info about an enzyme in
> breastmilk that could cause hyperbilirubinemia. Her baby, 3 wk old, born @
> 34 wks, thriving, gaining 4oz/wk, voids and yellow stools x 6-8/day was tx
> for bili of 20.6 with phototx for 2wks. Came off phototx 2days ago, bili
> now 16, back on phototx with orders from MD to stop breastfeeding and
> exclusively BOTTLE FEED formula as he suspects her breastmilk has an enzyme
>

I have quoted a few paragraphs from Breastfeeding, the text by Ruth Lawrence
(1999), p 486-487. I would encourage you to read the entire section for a
better understanding of breast milk jaundice.

"The syndrome of breastmilk jaundice was attributed by Arias et al to a
substance in the milk of some mothers that inhibits the hepatic enzyme
glucuronyl transferase,  preventing the conjucation of bilirubin. The
substance has been identified as . . . , a breakdown product of progesterone
and an isomer of pregnanediol that is not usually found in millk but occurs
normally in about 10% of the lactating population. Although this substance
had also been isolated from the milk and serum of mothers whose infants were
not jaundiced, this work has not been duplicated."

"The role of lipoprotein lipase and bile salt-stimulated lipase in breaast
milk jaundice continues under investigation. The role of free fatty acids and
the possibility of abnormal lipases are unresolved. The undisputed cause of
breast milk jaundice continues to elude investigators."

Lawrence recommends: "To establish the diagnosis firmly, and this is
necessary when the bilirubin level is above 16 mg/dl for more than 24 hours,
a bilirubin reading should be obtained 2 hours after a breastfeeding and then
breastfeeding discontinued for at least 12 hours. The infant must be fed
fluids and calories. . . . After at least 12 hours without the mother's
millk, the bilirubin level should be measured. If a significant drop of more
than 2 mg/dl occurs, it is diagnostic. When the level is below 15 mg/dl, th
infant can be put to the breast. Bilirubin levels should be obtained to
determine if the bilirubin rises again and , if so, how much. In most cases,
in the time not breastfeeding the infant's body equilibrates the levels
sufficiently, so there is only a slight increase in bilirubin on return to
breastfeeding followed by a slow but steady drop. If that is the case,
breastfeeding can continue. . . .

If the bilirubin has not dropped significantly after 12 hours off the breast,
the time off the breast should be extended to 18 to 24 hours, measuring bili
levels every 6 hours. If the bili rises whil the infant is off the breast,
the cause of jaundice is clearly not the breast milk; breastfeeding should be
resumed and other causes for the jaundice reevaluated."

Laura Hart
Winter Park, FL

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