Case Study Example. Breast Milk Jaundice: Diagnosis and Treatment

1.The three-differential diagnosis

The child was diagnosed with breastfeeding jaundice, and the following disorders represent the differential diagnosis of the illness. The first one is acute anemia, which is described by a reduction in the number of red blood cells in the circulation system. It is also characterized by a reduced volume of hemoglobin, and the condition can either be chronic or acute. Hemolysis and hemorrhage could be linked to this problem (Basu, Kaur, & Kaur, 2011). Also, children born with low weight are at risk of becoming anemic (Meinzen-Derr, Guerrero, Altaye, Ortega-Gallegos, Ruiz-Palacio & Morrow, 2006). During lactation iron mineral declines in the breast milk, and the disorder may occur. The second condition is neonatal jaundice, where the infant reveals a yellow color on the skins and their sclera (Ng, & How, 2015). It develops within the first week after the baby has been born. It is frequently caused by a buildup of unconjugated bilirubin in the blood, leading to a condition known as hyperbilirubinemia (Maisels & McDonagh, 2008 and Moerschel, Cianciaruso, & Tracy, 2008). The third one is the hemolytic disease of the newborn, where the maternal antibodies move through the placenta and destroy the infant's red cells (Basu, Kaur, & Kaur, 2011)). The outcome is anemia or also hyperbilirubinemia.

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2. The diagnosis for the patient and why.

At least one percent of newborns develop breast milk jaundice, which is caused by the presence of substances in the breast milk which leads to the inability of the body to excrete bilirubin. This condition happens to the infant of between five to seven days. Also, when the baby consumes less breast milk, they stand a risk of bowel movements (Kopelman, 2016). Drinking more breast milk can help in the excretion of bilirubin (Poland, 1981). The reason for this diagnosis is based on the presentation of the patient who is one week old and had bowel movements and jaundice on presentation. According to the above descriptions, breast milk jaundice can only occur between the fifth and the seventh day after the infant is born.

3. The unique characteristics of breast milk jaundice as the primary diagnosis.

A test would be conducted to evaluate the amount of bilirubin in the blood of the infant after the mother has been assessed whether she breastfeed the baby appropriately. More bilirubin in the blood will indicate that the infant has jaundice.

4. The treatment and management plan for the patient

The type bilirubinemia shown in this case is unconjugated due to the variation in the blood types of the mother and the infant. The mother had blood type A+ while the child had A, a condition which could be linked to the occurrence of the illness. The infants bilirubinemia can be treated by improving the frequency of breastfeeding (Leung & Sauve, 1989).

5. The strategies for educating patients and families on the treatment and management

The plans include posters, fliers, and pamphlets with information that encouraged mothers to provide supplemental breast milk. Also they can be advised to provide their children with dextrose water (Moerschel et al., 2008)). For the dehydrated infants, provision of intravenous fluids can be promoted. Phototherapy is also vital during the treatment programs for children who require intensive phototherapy and should be done from home. The mothers can be advised to consider the age of the baby to understand the appropriate time to initiate phototherapy.

Conclusion

Differential diagnosis is important to help in coming up with all possible underlying causes of illness before coming up with a conclusion. The differential diagnosis for breast milk jaundice includes hemolytic disease of the newborn, acute anemia, and neonatal jaundice. Not less than two-thirds of infants develop jaundice soon after birth (Schwartz, Haberman, & Ruddy, 2011). The child in the case study was suffering from breast milk jaundice, and the bowel movements were as a result of the poor breastfeeding that led to bilirubinemia. The most convenient treatment was increasing the frequency of breastfeeding (Leung & Sauve, 1989).

References

Basu, S., Kaur, R., & Kaur, G. (2011). Hemolytic disease of the fetus and newborn: Currenttrends and perspectives. Asian journal of transfusion science, 5(1), 3.

Kopelman, A. (2016). Jaundice in Newborns - Children's Health Issues. Retrieved January 11, 2017, from http://www.merckmanuals.com/home/children-s-health-issues/problems-in-newborns/jaundice-in-newbornsLeung, A. K., & Sauve, R. S. (1989). Breastfeeding and breast milk jaundice. The Journal of the Royal Society for the Promotion of Health, 109(6), 213-217.

Maisels, M. J., & McDonagh, A. F. (2008). Phototherapy for neonatal jaundice. New England Journal of Medicine, 358(9), 920-928.

Meinzen-Derr, J. K., Guerrero, M. L., Altaye, M., Ortega-Gallegos, H., Ruiz-Palacios, G. M., & Morrow, A. L. (2006). The risk of infant anemia is associated with exclusive breastfeedingand maternal anemia in a Mexican cohort. The Journal of Nutrition, 136(2), 452-458.

Moerschel, S. K., Cianciaruso, L. B., & Tracy, L. R. (2008). A practical approach to neonataljaundice. American family physician, 77(9).

Ng, M. C. W., & How, C. H. (2015). When babies turn yellow. Singapore medical journal, 56(11), 599.

Poland, R. L. (1981). Breast-milk jaundice. The Journal of Pediatrics, 99(1), 86-88.

Schwartz, H. P., Haberman, B. E., & Ruddy, R. M. (2011). Hyperbilirubinemia: currentguidelines and emerging therapies. Pediatric emergency care, 27(9), 884-889.