Epidemiology

Etiology

Pathophysiology

Subtypes and variants

Breastfeeding jaundice

• Definition: a type of neonatal jaundice caused by insufficient breastfeeding
• Pathophysiology: insufficient breast milk intake → lack of calories and inadequate quantities of bowel movements to remove bilirubin from the body → ↑ enterohepatic circulation → increased reabsorption of bilirubin from the intestines → unconjugated hyperbilirubinemia
• Clinical features: onset within 1 week

Breast milk jaundice

• Definition: a type of neonatal jaundice caused by increased levels of β-glucuronidase in maternal breast milk
• Pathophysiology: increased concentration of β-glucuronidase in breast milk → ↑ deconjugation and reabsorption of bilirubin → persistence of physiologic jaundice with unconjugated hyperbilirubinemia
  • β-Glucuronidase is found in breast milk and the intestinal brush border.
  • Deconjugation of bilirubin by bacterial β-glucuronidase can lead to pigment stone formation.
• Clinical features: onset within 2 weeks after birth; lasts for 4–13 weeks
• Treatment
  • Continued breastfeeding and supplementation with formula feeds
  • Phototherapy, if required

Clinical features

Diagnostics

Treatment

Complications

Kernicterus (chronic bilirubin encephalopathy)

• Develops over first years of life
• Pathophysiology: deposition of unconjugated bilirubin (liposoluble) in the basal ganglia and/or brain stem nuclei
• Clinical features
  • Cerebral paresis, hearing impairment, vertical gaze palsy
  • Movement disorder (choreoathetosis)