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母乳喂养早产儿出现 Gilbert 综合征所致迁延性黄疸。

Prolonged Jaundice in a Premature Breastfed Infant With Gilbert's Syndrome.

机构信息

School of Life Sciences, Technical University of Munich, Munich, Germany.

Chair of Public Health and Health Services Research, Institute for Medical Information Processing, Biometry and Epidemiology, Pettenkoffer School of Public Health, Faculty of Medicine, Ludwig-Maximilians-Universität München (LMU Munich), Munich, Germany.

出版信息

J Hum Lact. 2024 May;40(2):270-275. doi: 10.1177/08903344241227226. Epub 2024 Feb 9.

DOI:10.1177/08903344241227226
PMID:38334089
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11015704/
Abstract

INTRODUCTION

Neonatal jaundice and prematurity pose significant barriers to breastfeeding in the first days of life. There is limited literature exploring the relationship between prolonged jaundice in breastfed infants and Gilbert's (Meulengraght) syndrome. This case study describes the diagnostic and therapeutic challenges associated with Gilbert's syndrome in a late preterm breastfed infant born in Germany.

MAIN ISSUE

In this case report, an infant born to a primipara woman presented at 3 weeks postpartum to an International Board Certified Lactation Consultant. The initial assessment revealed a late preterm infant with inadequate weight gain and jaundice. The dyad received breastfeeding support and eventually achieved adequate weight gain; however, the infant's jaundice persisted.

MANAGEMENT

The consulting midwife suggested that the persistent jaundice was "breastmilk jaundice" and recommended temporarily interrupting breastfeeding. Due to a suspected family history of Gilbert's Syndrome, the dyad was referred, instead, to a pediatric gastroenterologist. Pathologic liver disease was excluded, and genetic testing confirmed Gilbert's Syndrome. At 6 months of age, the dyad was successfully breastfeeding and beginning complementary feeding.

CONCLUSION

Genetic testing for Gilbert's Syndrome should be considered for infants with prolonged jaundice and positive family history. Interruption or cessation of breastfeeding are not evidence-based recommendations, and current guidelines do not support these practices. Lactation professionals play a critical role in the management of breastfeeding for preterm infants with prolonged jaundice and should refer to specialists to rule out pathologic etiologies.

摘要

介绍

新生儿黄疸和早产会在生命的最初几天对母乳喂养造成重大障碍。目前关于母乳喂养婴儿黄疸持续时间与吉尔伯特(梅伦格拉特)综合征之间关系的文献有限。本病例研究描述了在德国出生的晚期早产儿母乳喂养婴儿中与吉尔伯特综合征相关的诊断和治疗挑战。

主要问题

在本病例报告中,一名初产妇的婴儿在产后 3 周时由国际认证哺乳顾问(International Board Certified Lactation Consultant)就诊。最初的评估显示,婴儿为晚期早产儿,体重增长不足且有黄疸。母婴二人接受了母乳喂养支持,最终实现了足够的体重增长,但婴儿的黄疸仍持续存在。

处理方法

咨询助产士建议,认为持续的黄疸是“母乳性黄疸”,建议暂时中断母乳喂养。由于怀疑有吉尔伯特综合征家族史,母婴二人被转介给儿科胃肠病学家。排除了病理性肝脏疾病,并通过基因检测确认了吉尔伯特综合征。在 6 个月大时,母婴二人成功开始母乳喂养并添加了补充食物。

结论

对于黄疸持续时间长且有阳性家族史的婴儿,应考虑进行吉尔伯特综合征的基因检测。中断或停止母乳喂养不是基于证据的推荐,目前的指南并不支持这些做法。哺乳专业人员在管理黄疸持续时间长的早产儿母乳喂养方面发挥着关键作用,应转介给专家以排除病理性病因。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e450/11015704/daafbf136bbd/10.1177_08903344241227226-fig1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e450/11015704/daafbf136bbd/10.1177_08903344241227226-fig1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e450/11015704/daafbf136bbd/10.1177_08903344241227226-fig1.jpg

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本文引用的文献

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Breast Milk Constituents and the Development of Breast Milk Jaundice in Neonates: A Systematic Review.母乳成分与新生儿母乳性黄疸的发生:系统评价。
Nutrients. 2023 May 10;15(10):2261. doi: 10.3390/nu15102261.
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UGT1A1*6 mutation associated with the occurrence and severity in infants with prolonged jaundice.
Front Pediatr. 2022 Dec 20;10:1080212. doi: 10.3389/fped.2022.1080212. eCollection 2022.
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Clinical Practice Guideline Revision: Management of Hyperbilirubinemia in the Newborn Infant 35 or More Weeks of Gestation.临床实践指南修订:孕35周及以上新生儿高胆红素血症的管理
Pediatrics. 2022 Sep 1;150(3). doi: 10.1542/peds.2022-058859.
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Breastfeeding in Relation to Neonatal Jaundice in the First Week After Birth: Parents' Perceptions and Clinical Measurements.母乳喂养与新生儿出生后第一周内黄疸的关系:父母的看法和临床测量。
Breastfeed Med. 2021 Apr;16(4):292-299. doi: 10.1089/bfm.2020.0293. Epub 2021 Mar 5.
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Overview of Gilbert's syndrome.吉尔伯特综合征概述。
Drug Ther Bull. 2019 Feb;57(2):27-31. doi: 10.1136/dtb.2018.000028.
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Breastfeeding Rates and Programs in Europe: A Survey of 11 National Breastfeeding Committees and Representatives.欧洲的母乳喂养率和项目:对 11 个国家母乳喂养委员会和代表的调查。
J Pediatr Gastroenterol Nutr. 2019 Mar;68(3):400-407. doi: 10.1097/MPG.0000000000002234.
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Neonatal hyperbilirubinaemia: a global perspective.新生儿高胆红素血症:全球视角。
Lancet Child Adolesc Health. 2018 Aug;2(8):610-620. doi: 10.1016/S2352-4642(18)30139-1. Epub 2018 Jun 28.
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ABM Clinical Protocol #29: Iron, Zinc, and Vitamin D Supplementation During Breastfeeding.ABM临床方案#29:母乳喂养期间补充铁、锌和维生素D。
Breastfeed Med. 2018 Jul/Aug;13(6):398-404. doi: 10.1089/bfm.2018.29095.snt.
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ABM Clinical Protocol #22: Guidelines for Management of Jaundice in the Breastfeeding Infant 35 Weeks or More of Gestation-Revised 2017.美国儿科学会临床协议#22:孕35周及以上母乳喂养婴儿黄疸管理指南——2017年修订版
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ABM Clinical Protocol #10: Breastfeeding the Late Preterm (34-36 6/7 Weeks of Gestation) and Early Term Infants (37-38 6/7 Weeks of Gestation), Second Revision 2016.ABM临床方案#10:晚期早产儿(妊娠34 - 36 6/7周)和早期足月儿(妊娠37 - 38 6/7周)的母乳喂养,2016年第二次修订版
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