Желтуха грудного молока
https://doi.org/10.15690/vsp.v22i6.2656
Аннотация
Представлены результаты современных исследований патогенеза желтухи грудного молока — распространенной формы неонатальной желтухи. Охарактеризованы основные факторы риска, а также методы диагностики, позволяющие исключить другие формы желтушного синдрома при рецидивирующих и затяжных желтухах у новорожденных. Представлены основные подходы к терапии желтухи грудного молока. Обсуждены дискуссионные вопросы показаний к использованию фототерапии. Обоснована целесообразность сохранения грудного вскармливания при развитии желтухи грудного молока. Несмотря на относительно благоприятное течение и исходы желтухи грудного молока, это состояние требует внимания педиатров. Отмечена необходимость продолжения исследований патогенетической терапии пациентов с желтухой грудного молока.
Об авторах
И. А. Беляева
Морозовская ДГКБ; РНИМУ им. Н.И. Пирогова; НИИ педиатрии и охраны здоровья детей НКЦ №2 ФГБНУ «РНЦХ им. акад. Б.В. Петровского»
Россия
Раскрытие интересов:
Россия
Беляева Ирина Анатольевна - доктор медицинских наук, профессор Российской академии наук, заведующая отделом преконцепционной, антенатальной и неонатальной медицины НИИ педиатрии и охраны здоровья детей НКЦ №2 ФГБНУ «РНЦХ им. акад. Б.В. Петровского» Минобрнауки России; профессор кафедры факультетской педиатрии педиатрического факультета ФГАОУ ВО РНИМУ им. Н.И. Пирогова Минздрава России; врач-неонатолог ГБУЗ МДКБ ДЗМ.
119333, Москва, ул. Фотиевой, д. 10, к. 1
Тел.: +7 (905) 728-58-02
Раскрытие интересов:
И.А. Беляева — чтение лекций для компаний «Прогресс», «Акрихин», Bayer, «АстраЗенека»
Е. П. Бомбардирова
НИИ педиатрии и охраны здоровья детей НКЦ №2 ФГБНУ «РНЦХ им. акад. Б.В. Петровского»
Россия
Раскрытие интересов:
Россия
Москва
Раскрытие интересов:
Нет
Е. О. Курнатовская
Морозовская ДГКБ
Россия
Раскрытие интересов:
Россия
Москва
Раскрытие интересов:
Нет
Список литературы
1. Шабалов Н.П., Софронова Л.Н. Неонатология: в 2 т.: учебное пособие. — 7-е изд., перераб. и доп. — М.: ГЭОТАР-Медиа; 2020. — 720 с.
2. Newman AJ, Gross S. Hyperbilirubinemia in Breast-Fed Infants. Pediatrics. 1963;32(6):995-1001. doi: https://doi.org/10.1542/peds.32.6.995
3. Schneider AP 2nd. Breast milk jaundice in the newborn. A real entity. JAMA. 1986;255(23):3270-3274. doi: https://doi.org/10.1001/jama.1986.03370230076034
4. Неонатология: клинические рекомендации / под ред. Н.Н. Володина, Д.Н. Дегтярева, Д.С. Крючко. — М.: ГЭОТАР-Медиа; 2019. — 320 с.
5. Kemper AR, Newman TB, Slaughter JL, et al. Clinical Practice Guideline Revision: Management of Hyperbilirubinemia in the Newborn Infant 35 or More Weeks of Gestation. Pediatrics. 2022;150(3): e2022058859. doi: https://doi.org/10.1542/peds.2022-058859
6. Preer GL, Philipp BL. Understanding and managing breast milk jaundice. Arch Dis Child Fetal Neonatal Ed. 2011;96(6):F461- F466. doi: https://doi.org/10.1136/adc.2010.184416
7. Ullah S, Rahman K, Hedayati M. Hyperbilirubinemia in Neonates: Types, Causes, Clinical Examinations, Preventive Measures and Treatments: A Narrative Review Article. Iran J Public Health. 2016; 45(5):558-568.
8. Bratton S, Cantu RM, Stern M. Breast Milk Jaundice. 2023 Jan 17. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023.
9. Ketsuwan S, Baiya N, Maelhacharoenporn K, Puapornpong P. The Association of Breastfeeding Practices with Neonatal Jaundice. J Med Assoc Thai. 2017;100(3):255-261.
10. Noel-Weiss J, Courant G, Woodend AK. Physiological weight loss in the breastfed neonate: a systematic review. Open Med. 2008;2(4):e99-e110.
11. Huang H, Huang J, Huang W, et al. Breast milk jaundice affects breastfeeding: From the perspective of intestinal flora and SCFAs-GPR41/43. Front Nutr. 2023;10:1121213. doi: https://doi.org/10.3389/fnut.2023.1121213
12. Prameela KK. Breastfeeding during breast milk jaundice — a pathophysiological perspective. Med J Malaysia. 2019;74(6):527-533.
13. Levitt DG, Levitt MD. Quantitative assessment of the multiple processes responsible for bilirubin homeostasis in health and disease. Clin Exp Gastroenterol. 2014;7:307-328. doi: https://doi.org/10.2147/CEG.S64283
14. Flaherman VJ, Maisels MJ. ABM Clinical Protocol #22: Guidelines for Management of Jaundice in the Breastfeeding Infant 35 Weeks or More of Gestation-Revised 2017. Breastfeed Med. 2017;12(5): 250-257. doi: https://doi.org/10.1089/bfm.2017.29042.vjf
15. Deshpande PG, Aslam M. Breast Milk Jaundice. In: Medscape. Updated: Nov 18, 2021. Available online: https://emedicine.medscape.com/article/973629-overview. Accessed on November 22, 2023.
16. Maisels MJ, Clune S, Coleman K, et al. The natural history of jaundice in predominantly breastfed infants. Pediatrics. 2014; 134(2):e340-e345. doi: https://doi.org/10.1542/peds.2013-4299
17. Bentz MG, Carmona N, Bhagwat MM, et al. Beyond “Asian”: Specific East and Southeast Asian Races or Ethnicities Associated With Jaundice Readmission. Hosp Pediatr. 2018;8(5):269-273. doi: https://doi.org/10.1542/hpeds.2017-0234
18. Gao C, Guo Y, Huang M, et al. Breast Milk Constituents and the Development of Breast Milk Jaundice in Neonates: A Systematic Review. Nutrients. 2023;15(10):2261. doi: https://doi.org/10.3390/nu15102261
19. Arias IM, Gartner LM, Seifter S, Furman M. Prolonged neonatal unconjugated hyperbilirubinemia associated with breast feeding and a steroid, pregnane-3(alpha), 20(beta)-diol, in maternal milk that inhibits glucuronide formation in vitro. J Clin Invest. 1964; 43(11):2037-2047. doi: https://doi.org/10.1172/jci105078
20. Guo Q, Cui M, Liu X, et al. Effect of Epidermal Growth Factor in Human Milk and Maternal Diet on Late-Onset Breast Milk Jaundice: A Case-Control Study in Beijing. Nutrients. 2022;14(21):4587. doi: https://doi.org/10.3390/nu14214587
21. Demirkol M, Bohles H. Breast milk taurine and its possible influence on the development of breast milk induced jaundice of the neonate — a hypothesis. Adv Exp Med Biol. 1994;359:405-410. doi: https://doi.org/10.1007/978-1-4899-1471-2_42
22. Amato M, Howald H, von Muralt G. Fat Content of Human Milk and Breast Milk Jaundice. Acta Paediatr Int J Paediatr. 1985;74(5):805-806. doi: https://doi.org/10.1111/j.1651-2227.1985.tb10039.x
23. Poland RL, Schultz GE, Garg G. High milk lipase activity associated with breast milk jaundice. Pediatr Res. 1980;14:1328-1331. doi: https://doi.org/10.1203/00006450-198012000-00011
24. Forsyth JS, Donnet L, Ross PE. A study of the relationship between bile salts, bile salt-stimulated lipase, and free fatty acids in breast milk: Normal infants and those with breast milk jaundice. J Pediatr Gastroenterol Nutr. 1990;11(2):205-210. doi: https://doi.org/10.1097/00005176-199008000-00009
25. Shibuya A, Itoh T, Tukey RH, Fujiwara R. Impact of fatty acids on human UDP-glucuronosyltransferase 1A1 activity and its expression in neonatal hyperbilirubinemia. Sci Rep. 2013;3:2903. doi: https://doi.org/10.1038/srep02903
26. Foliot A, Ploussard JP, Housset E, Christoforov. Breast milk jaundice: In vitro inhibition of rat liver bilirubin-uridine diphosphate glucuronyltransferase activity and Z protein-bromosulfophthalein binding by human breast milk. Pediatr Res. 1976;10(6):594-598. doi: https://doi.org/10.1203/00006450-197606000-00007
27. Gao C, Miller J, Middleton PF, et al. Changes to breast milk fatty acid composition during storage, handling and processing: A systematic review. Prostaglandins Leukot Essent Fatty Acids. 2019;146:1-10. doi: https://doi.org/10.1016/j.plefa.2019.04.008
28. Manganaro R, Marseglia L, Mami C, et al. Serum alphafetoprotein (AFP) levels in breastfed infants with prolonged indirect hyperbilirubinemia. Early Hum Dev. 2008;84:487-490. doi: https://doi.org/10.1016/j.earlhumdev.2008.01.005
29. Apaydin K, Ermis B, Arasli M, et al. Cytokines in human milk and late-onset breast milk jaundice. Pediatr Int. 2012;54(6):801-805. doi: https://doi.org/10.1111/j.1442-200X.2012.03680.x
30. Kumral A, Ozkan H, Duman N, et al. Breast milk jaundice correlates with high levels of epidermal growth factor. Pediatr Res. 2009;66(2):218-221. doi: https://doi.org/10.1203/PDR.0b013e3181ac4a30
31. Li Y, Shen N, Li J, et al. Changes in intestinal Flora and Metabolites in neonates with breast Milk jaundice. Front Pediatr. 2020;8:177. doi: https://doi.org/10.3389/fped.2020.00177
32. McCarville JL, Chen GY, Cuevas VD, et al. Microbiota metabolites in health and disease. Annu Rev Immunol. 2020;38:147-170. doi: https://doi.org/10.1146/annurev-immunol-071219-125715
33. Agus A, Clément K, Sokol H. Gut microbiota-derived metabolites as central regulators in metabolic disorders. Gut. 2021;70(6): 1174-1182. doi: https://doi.org/10.1136/gutjnl-2020-323071
34. Gonçalves P, Araújo JR, Di Santo JP. A cross-talk between microbiota-derived short-chain fatty acids and the host mucosal immune system regulates intestinal homeostasis and inflammatory bowel disease. Inflamm Bowel Dis. 2018;24(3):558-572. doi: https://doi.org/10.1093/ibd/izx029
35. Kayama H, Okumura R, Takeda K. Interaction between the microbiota, epithelia, and immune cells in the intestine. Annu Rev Immunol. 2020;38:23-48. doi: https://doi.org/10.1146/annurev-immunol-070119-115104
36. Hansen TWR, Wong RJ, Stevenson DK. Molecular physiology and pathophysiology of bilirubin handling by the blood, liver, intestine, and brain in the newborn. Physiol Rev. 2020;100(3):1291-346. doi: https://doi.org/10.1152/physrev.00004.2019
37. Chen K, Yuan T. The role of microbiota in neonatal hyperbilirubinemia. Am J Transl Res. 2020;12:7459-7474.
38. Novák P Jackson AO, Zhao GJ, Yin K. Bilirubin in metabolic syndrome and associated inflammatory diseases: new perspectives. Life Sci. 2020;257:118032. doi: https://doi.org/10.1016/j.lfs.2020.118032
39. Ma J, Li Z, Zhang W, et al. Comparison of gut microbiota in exclusively breast-fed and formula-fed babies: a study of 91 term infants. Sci Rep. 2020;10:15792. doi: https://doi.org/10.1038/s41598-020-72635-x
40. Guo Q, Liu X, Cui M, et al. Characteristics of intestinal microbiota in infants with late-onset breast milk jaundice. Front Nutr. 2023;10: 1119768. doi: https://doi.org/10.3389/fnut.2023.1119768
41. Tukey RH, Strassburg CP. Human UDP-glucuronosyltransferases: metabolism, expression, and disease. Annu Rev Pharmacol Toxicol. 2000;40:581-616. doi: https://doi.org/10.1146/annurev.pharmtox.40.1.581.
42. Maisels MJ, Kring E. Rebound in serum bilirubin level following intensive phototherapy. Arch Pediatr Adolesc Med. 2002;156(7): 669-672. doi: https://doi.org/10.1001/archpedi.156.7.669
43. Fujiwara R, Maruo Y, Chen S, Tukey RH. Role of extrahepatic UDP-glucuronosyltransferase 1A1: Advances in understanding breast milk-induced neonatal hyperbilirubinemia. Toxicol Appl Pharmacol. 2015;289(1):124-132. doi: https://doi.org/10.1016/j.taap.2015.08.018
44. Maruo Y, Nishizawa K, Sato H, et al. Prolonged unconjugated hyperbilirubinemia associated with breast milk and mutations of the bilirubin uridine diphosphate- glucuronosyltransferase gene. Pediatrics. 2000;106(5):E59. doi: https://doi.org/10.1542/peds.106.5.e59
45. Fujiwara R, Chen S, Karin M, Tukey RH. Reduced expression of UGT1A1 in intestines of humanized UGT1 mice via inactivation of NF-kB leads to hyperbilirubinemia. Gastroenterology. 2012;142(1): 109-118. doi: https://doi.org/10.1053/j.gastro.2011.09.045
46. Assenat E, Gerbal-Chaloin S, Larrey D, et al. Interleukin 1beta inhibits CAR-induced expression of hepatic genes involved in drug and bilirubin clearance. Hepatology. 2004;40(4):951-960. doi: https://doi.org/10.1002/hep.20387
47. Sumida K, Kawana M, Kouno E, et al. Importance of UDP-glucuronosyltransferase 1A1 expression in skin and its induction by UVB in neonatal hyperbilirubinemia. Mol Pharmacol. 2013;84(5): 679-686. doi: https://doi.org/10.1124/mol.113.088112
48. Ota Y Maruo Y Matsui K, et al. Inhibitory effect of 5e-pregnane-3a,20e-diol on transcriptional activity and enzyme activity of human bilirubin UDP-glucuronosyltransferase. Pediatr Res. 2011;70(5): 453-457. doi: https://doi.org/10.1203/PDR.0b013e31822f242e
49. Muchowski KE. Evaluation and treatment of neonatal hyperbilirubinemia. Am Fam Physician. 2014;89(11):873-878.
50. Xiao LL, Zhang XF, Wang XY. Changes in epidermal growth factor concentrations in neonates with late-onset breast milk jaundice after stopping breast feeding. Zhongguo Dang Dai Er Ke Za Zhi. 2013;15(12):1079-1081.
51. Fawaz R, Baumann U, Ekong U, et al. Guideline for the Evaluation of Cholestatic Jaundice in Infants: Joint Recommendations of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition. J Pediatr Gastroenterol Nutr. 2017;64(1):154-168. doi: https://doi.org/10.1097/MPG.0000000000001334
52. Banakar MK, Subbarayan A. A study of prolonged jaundice screen in healthy term babies. Indian J Clin Biochem. 2008;23(3):286-289. doi: https://doi.org/10.1007/s12291-008-0064-9
53. Kaplan M, Kaplan E, Hammerman C, et al. Post-phototherapy neonatal bilirubin rebound: a potential cause of significant hyperbilirubinaemia. Arch Dis Child. 2006;91(1):31-34. https://doi.org/doi:10.1136/adc.2005.081224
54. Chang PW, Kuzniewicz MW, McCulloch CE, Newman TB. A Clinical Prediction Rule for Rebound Hyperbilirubinemia Following Inpatient Phototherapy. Pediatrics. 2017;139(3):e20162896. doi: https://doi.org/10.1542/peds.2016-2896
55. So V, Coo H, Khurshid F. Validation of published rebound hyperbilirubinemia risk prediction scores during birth hospitalization after initial phototherapy: a retrospective chart review. Pediatr Res. 2022; 91(4):888-895. doi: https://doi.org/10.1038/s41390-021-01478-7
56. Sachdeva M, Murki S, Oleti TP, Kandraju H. Intermittent versus continuous phototherapy for the treatment of neonatal non-hemolytic moderate hyperbilirubinemia in infants more than 34 weeks of gestational age: a randomized controlled trial. Eur J Pediatr. 2015; 174(2):177-181. doi: https://doi.org/10.1007/s00431-014-2373-8
57. Pettersson M, Eriksson M, Odlind A, Ohlin A. Home phototherapy of term neonates improves parental bonding and stress: findings from a randomized controlled trial. Acta Paediatr. 2022;111(4): 760-766. doi: https://doi.org/10.1111/apa.16231
58. Awad MH, Amer S, Hafez M, et al. Fenofibrate as an adjuvant to phototherapy in pathological unconjugated hyperbilirubinemia in neonates: a randomized control trial. J Perinatol. 2021;41(4): 865-872. doi: https://doi.org/10.1038/s41372-020-00861-2
59. Lazarus G, Francie J, Roeslani RD, et al. Role of ursodeoxycholic acid in neonatal indirect hyperbilirubinemia: a systematic review and meta-analysis of randomized controlled trials. Ital J Pediatr. 2022; 48(1):179. doi: https://doi.org/10.1186/s13052-022-01372-w
60. Mutlu M, Aslan Y, Kader Ş, Aktürk Acar F. Preventive Effects of Probiotic Supplementation on Neonatal Hyperbilirubinemia Caused by Isoimmunization. Am J Perinatol. 2020;37(11):1173-1176. doi: https://doi.org/10.1055/s-0039-1692690
61. Nuzzi G, Trambusti I, DI Cicco ME, Peroni DG. Breast milk: more than just nutrition! Minerva Pediatr (Torino). 2021;73(2):111-114. doi: https://doi.org/10.23736/S2724-5276.21.06223-X
62. Geddes DT, Gridneva Z, Perrella SL, et al. 25 Years of Research in Human Lactation: From Discovery to Translation. Nutrients. 2021;13(9):3071. doi: https://doi.org/10.3390/nu13093071
63. Rahkonen P, Heinonen K, Pesonen AK, et al. Mother-child interaction is associated with neurocognitive outcome in extremely low gestational age children. Scand J Psychol. 2014;55(4): 311-318. doi: https://doi.org/10.1111/sjop.12133
64. Liu J, Leung P, Yang A. Breastfeeding and active bonding protects against children's internalizing behavior problems. Nutrients. 2013;6(1):76-89. doi: https://doi.org/10.3390/nu6010076
65. Vidavalur R, Devapatla S. Trends in hospitalizations of newborns with hyperbilirubinemia and kernicterus in United States: an epidemiological study. J Matern Fetal Neonatal Med. 2022;35(25):7701-7706. doi: https://doi.org/10.1080/14767058.2021.1960970
66. Alkén J, Håkansson S, Ekéus C, et al. Rates of Extreme Neonatal Hyperbilirubinemia and Kernicterus in Children and Adherence to National Guidelines for Screening, Diagnosis, and Treatment in Sweden. JAMA Netw Open. 2019;2(3):e190858. doi: https://doi.org/10.1001/jamanetworkopen.2019.0858
67. McNamara RK, Vannest JJ, Valentine CJ. Role of perinatal long-chain omega-3 fatty acids in cortical circuit maturation: Mechanisms and implications for psychopathology. World J Psychiatry. 2015;5(1):15-34. doi: https://doi.org/10.5498/wjp.v5.i1.15
68. Anderson JW, Johnstone BM, Remley DT. Breast feeding and cognitive development: a meta-analysis. Am J Clin Nutr. 1999; 70(4):525-535. doi: https://doi.org/10.1093/ajcn/70.4.525
69. Kramer MS, Aboud F, Mironova E, et al. Breastfeeding and child cognitive development: new evidence from a large randomized trial. Arch Gen Psychiatry. 2008;65(5):578-584. doi: https://doi.org/10.1001/archpsyc.65.5.578
70. Horta BL, Loret de Mola C, Victora CG. Breastfeeding and intelligence: a systematic review and meta-analysis. Acta Paediatr. 2015;104(467):14-19. doi: https://doi.org/10.1111/apa.13139
71. Deoni SCL, Dean DC, Piryatinsky I, et al. Breastfeeding and early white matter development: A cross-sectional study. Neuroimage. 2013;82:77-86. doi: https://doi.org/10.1016/j.neuroimage.2013.05.090
72. Schött U, Solomon C, Fries D, Bentzer P The endothelial glycocalyx and its disruption, protection and regeneration: a narrative review. Scand J Trauma Resusc Emerg Med. 2016; 24:48. doi: https://doi.org/10.1186/s13049-016-0239-y
73. Kutuzov N, Flyvbjerg H, Lauritzen M. Contributions of the glycocalyx, endothelium, and extravascular compartment to the blood-brain barrier. Proc Natl Acad Sci USA. 2018;115(40): E9429-E9438. doi: https://doi.org/10.1073/pnas.1802155115
74. Liu B, Newburg DS. Human milk glycoproteins protect infants against human pathogens. Breastfeed Med. 2013;8(4):354-362. doi: https://doi.org/10.1089/bfm.2013.0016
75. Hassiotou F, Beltran A, Chetwynd E, et al. Breastmilk is a novel source of stem cells with multilineage differentiation potential. Stem Cells. 2012;30(10):2164-2174. doi: https://doi.org/10.1002/stem.1188
76. Velasco I, Santos C, Limon J, et al. Bioactive components in human milk along the first month of life: effects of iodine supplementation during pregnancy. Ann Nutr Metab. 2016;68(2):130-136. doi: https://doi.org/10.1159/000443800
77. Aydin MS, Yiğit EN, Vatandaşlar E, et al. Transfer and integration of breast milk stem cells to the brain of suckling pups. Sci Rep. 2018; 8(1):4289. doi: https://doi.org/10.1038/s41598-018-32715-5
78. Irmak MK, Oztas Y, Oztas E. Integration of maternal genome into the neonate genome through breast milk mRNA transcripts and reverse transcriptase. Theor Biol Med Model. 2012;9:20. doi: https://doi.org/10.1186/1742-4682-9-20
79. Păduraru L, Dimitriu DC, Avasiloaiei AL, et al. Total antioxidant status in fresh and stored human milk from mothers of term and preterm neonates. Pediatr Neonatol. 2018;59(6):600-605. doi: https://doi.org/10.1016/j.pedneo.2018.02.004
80. DiNicolantonio JJ, McCarty MF, O'Keefe JH. Antioxidant bilirubin works in multiple ways to reduce risk for obesity and its health complications. Open Heart. 2018;5(2):e000914. doi: https://doi.org/10.1136/openhrt-2018-000914
81. Hansen R, Gibson S, De Paiva Alves E, et al. Adaptive response of neonatal sepsis-derived Group B Streptococcus to bilirubin. Sci Rep. 2018;8(1):6470. doi: https://doi.org/10.1038/s41598-018-24811-3
82. Altuntaş N. Is There Any Effect of Hyperbilirubinemia on Breastfeeding? If Any, at Which Level? Breastfeed Med. 2020;15(1):29-34. doi: https://doi.org/10.1089/bfm.2019.0176
83. Huang Y, Chen L, Wang X, et al. Maternal knowledge, attitudes and practices related to neonatal jaundice and associated factors in Shenzhen, China: a facility-based cross-sectional study. BMJ Open. 2022;12(8):e057981. doi: https://doi.org/10.1136/bmjopen-2021-057981
84. Chu KH, Teng SW, Tai CJ, et al. Does Jaundice in Newborn Infants Affect Exclusivity and Duration of Breastfeeding in Taiwan? J Nurs Res. 2021;29(2):e145. doi: https://doi.org/10.1097/jnr.0000000000000420
85. Hokkanen L, Launes J, Michelsson K. Adult neurobehavioral outcome of hyperbilirubinemia in full term neonates — A 30 year prospective follow-up study. PeerJ. 2014;2:e294. doi: https://doi.org/10.7717/peerj.294
86. Tsao PC, Yeh HL, Shiau YS, et al. Long-term neurodevelopmental outcomes of significant neonatal jaundice in Taiwan from 20002003: A nationwide, population-based cohort study. Sci Rep. 2020; 10(1):11374. doi: https://doi.org/10.1038/s41598-020-68186-w
87. Chiu YW, Cheng SW, Yang CY, Weng YH. Breastfeeding in Relation to Neonatal Jaundice in the First Week After Birth: Parents' Perceptions and Clinical Measurements. Breastfeed Med. 2021; 16(4):292-299. doi: https://doi.org/10.1089/bfm.2020.0293
Рецензия
Для цитирования:
Беляева И.А., Бомбардирова Е.П., Курнатовская Е.О. Желтуха грудного молока. Вопросы современной педиатрии. 2023;22(6):498-505. https://doi.org/10.15690/vsp.v22i6.2656
For citation:
Belyaeva I.A., Bombardirova E.P., Kurnatovskaya E.O. Breast Milk Jaundice. Current Pediatrics. 2023;22(6):498-505. (In Russ.) https://doi.org/10.15690/vsp.v22i6.2656
Просмотров:
1517
Послать статью по эл. почте 
