Neonatal Jaundice Pathologic  -  Recirculation
Pathologic jaundice Enteric recirculation		Jaundice associated with breast feeding occurs in the first days of life in breast-fed infants. Many factors can come together to cause a state of relative underhydration and malnourishment, leading to delayed passage of meconium and increased enteric reabsorption of bilirubin. Late breast milk jaundice occurs after 5 days of age in breast fed babies who are well and gaining weight with normal exam and intestinal function. It is clear that the underlying mechanism here is increased enteric reabsorption of bilirubin. What is unclear is the exact etiolgy. Since these babies are well, discontinuation of breast feeding, even temporarily, is not recommended unless serum bilirubins are approaching dangerous levels. Some newborns with duodenal and jejunal obstructions also have exaggerated unconjugated hyperbilirubinemia. Lower intestinal obstructions, such as Hirschprung's disease, can also result in hyperbilirubinemia, although usually to a lesser degree. Surgical relief of the obstruction results in a decline of serum bilirubins to normal within 2 to 3 days. In all of these cases, increased enteric reabsorption of bilirubin is thought to be the cause of the jaundice. Return to top of page