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[Icterus prolongatus is a reason for laboratory investigation, also in breastfed neonates]
J Bekhof1, Z J de Langen, H J Verkade
1Afd. Kindergastro-enterologie, Universitair Medisch Centrum Groningen, locatie Beatrix Kinderkliniek, Postbus 30.001, 9700 RB Groningen.
Insights
Jaundice in breastfed infants can be serious. Early lab tests are crucial to distinguish serious conditions like biliary atresia from harmless breastfeeding jaundice.
Area of Science:
- Neonatal Medicine
- Pediatric Gastroenterology
- Hepatology
Background:
- Neonatal jaundice is common, often attributed to breastfeeding.
- Distinguishing pathological causes from benign breastfeeding jaundice is critical for timely intervention.
Observation:
- Three infants presented with jaundice while breastfeeding.
- Two older infants were diagnosed with biliary atresia, requiring surgical intervention and liver transplantation.
- The youngest infant's jaundice resolved spontaneously, likely due to breastfeeding.
Findings:
- Biliary atresia can present as jaundice in breastfed neonates.
- Prompt diagnosis through physical examination and biochemical tests (bilirubin, GGT) is vital.
- Delayed diagnosis can lead to severe liver damage and the need for transplantation.
Implications:
- Healthcare providers must consider serious conditions in jaundiced neonates, even if breastfeeding.
- Early laboratory investigation is recommended for neonates with jaundice beyond three weeks of age.
- Timely diagnosis and management of neonatal cholestasis syndromes improve patient outcomes.
Abstract:
Three infants, a boy aged 4 months and two girls aged 3 months and 6 weeks, respectively, had jaundice while they were breastfed. Until then, the jaundice had been interpreted as an innocent consequence of the breastfeeding. In the two eldest patients, however, biliary atresia was diagnosed. A hepatoportoenterostomy was performed in the girl when she was 15 weeks old, but both ultimately underwent a liver transplantation with a good clinical outcome. In the youngest patient, the jaundice disappeared spontaneously and retrospectively was indeed probably associated with breastfeeding. Thorough physical examination and biochemical analyses (total and direct bilirubin, gamma-glutamyl-transferase) are important for the identification of neonatal cholestasis syndromes. Laboratory investigation is recommended in any neonate jaundiced after the age of 3 weeks to differentiate pathological neonatal cholestasis from prolonged jaundice related to breastfeeding.
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