Breast Milk Constituents and the Development of Breast Milk Jaundice in Neonates: A Systematic Review

Abstract

Breast milk is tailored for optimal growth in all infants; however, in some infants, it is related to a unique phenomenon referred to as breast milk jaundice (BMJ). BMJ is a type of prolonged unconjugated hyperbilirubinemia that is often late onset in otherwise healthy-appearing newborns, and its occurrence might be related to breast milk itself. This review aims to systematically evaluate evidence regarding breast milk composition and the development of BMJ in healthy neonates. PubMed, Scopus and Embase were searched up to 13 February 2023 with key search terms, including neonates, hyperbilirubinemia, and breastfeeding. A total of 678 unique studies were identified and 12 were ultimately included in the systematic review with narrative synthesis. These included studies covered both nutritional compositions (e.g., fats and proteins) and bioactive factors (e.g., enzymes and growth factors) of breast milk and formally assessed the difference in the concentration (or presence) of various endogenous components of breast milk collected from mothers of BMJ infants and healthy infants. The results were inconsistent and inconclusive for most of the substances of interest, and there was only a single study available (e.g., total energy and mineral content, bile salts and cytokines); conflicting or even contradictory results arose when there were two or more studies on the subject matter (e.g., fats and free fatty acids contents and epidermal growth factor). The etiology of BMJ is likely multifactorial, and no single constituent of breast milk could explain all the BMJ cases observed. Further well-designed studies are warranted to investigate the complex interaction between maternal physiology, the breast milk system and infant physiology before this field could be progressed to uncover the etiology of BMJ.

Prolonged Jaundice in a Premature Breastfed Infant With Gilbert’s Syndrome

“…Similar interpretation of findings were published in a more recent retrospective case-control study of 324 infants in China ( Yang et al, 2022 ). However, a systematic review on human milk constituents and the development of “breast milk jaundice” states that “breast milk jaundice” is likely multifactorial, since no single constituent of human milk could yet explain all human milk jaundice cases observed ( Gao et al, 2023 ). It is unclear, therefore, why these epidemiological studies interpret human milk as a causal risk factor for infant jaundice based solely on the risk differences between breastfed and formula fed groups.…”

Breast Milk Jaundice

“…Такая концентрация общего билирубина ассоциирована с высоким риском затяжной (более 14 сут) желтухи [7,8]. Частота развития желтухи грудного молока не зависит от расы детей или региона их проживания, хотя неонатальные желтухи чаще диагностируют у представителей монголоидной расы [8,17,18].…”

“…Вместе с тем сообщалось о связи «молочной» желтухи с относительно высокой концентрацией в грудном молоке аминокислоты таурина [21], жира [22] и свободных жирных кислот [23], хотя в других работах эти наблюдения не были подтверждены [20,24]. Как известно, свободные жирные кислоты обладают свойством тормозить метаболизм билирубина [18]. Способность длинноцепочечных моно-и полиненасыщенных жирных кислот ингибировать конъюгацию билирубина обусловлена их свойством подавлять печеночную и кишечную глюкуронилтрансферазу [25].…”

“…новорожденных) установлено, что у 7-летних детей, перенесших значительную неонатальную желтуху, частота детского церебрального паралича, потери слуха, речевых расстройств (дизартрия, дислалия), умственной отсталости, задержки психомоторного развития, синдрома дефицита внимания с гиперактивностью и расстройств аутистического спектра были в 1,5-3 раза выше, чем в контрольной группе (дети без такой желтухи) [86]. Помимо этого, считается, что для детей с желтухой материнского молока характерен высокий риск инфекций вследствие отказа матерей от кормления грудью из-за опасения вредного влияния желтухи, а также из-за задержки вакцинации [18,87].…”

“Light” on Phototherapy—Complications and Strategies for Shortening Its Duration, A Review of the Literature

“…Neonatal hyperbilirubinemia (NHB) is an extremely common metabolic complication in newborns, affecting over 60% of term infants and around 80% of preterm infants in the first days of life. Approximately 10% of breastfed infants have persistent jaundice during the first few weeks after birth [1][2][3][4]. Neonatal jaundice presents with yellowish discoloration evident on the skin, and in mucous membranes and sclera.…”