母乳颜色为什么变成绿色了？

如何解释，又如何应对？今天文献阅读笔记的就是关于绿色母乳的病例。

蓝绿藻胶囊摄入后的绿色母乳：一例报告

Green Breast Milk Following Ingestion of Blue-Green Algae: A Case Report

摘要

母乳是新生儿良好的营养来源，其颜色的变化会引起母亲和医生的警觉，并可能阻止母乳喂养。据报道，母乳有不同的颜色，如血染、蓝色和蓝绿色。我们报告了一例由母亲在分娩前后摄入蓝绿藻胶囊引起的绿色母乳。Naranjo药物不良反应概率量表评分为5分，表明可能发生药物不良反应。实验室分析没有发现母乳有其他异常。母亲停止服用补充剂，3天后牛奶恢复正常外观。该报告提醒医生将营养补充剂致母乳性状改变纳入年轻母亲的母乳喂养健康宣教中。

Abstract

Breast milk is an excellent nutritional source for newborns, and a change in its color can be alarming to both mother and physician, and may prevent breastfeeding. Different colors of breast milk have been reported such as blood-stained, blue, and bluish-green. We present the rst case of green breast milk caused by maternal ingestion of blue-green algae pills immediately before and after delivery. The score on the Naranjo Adverse Drug Reaction Probability Scale was 5, indicating a probable adverse drug reaction. Laboratory analysis yielded no other abnormalities in the milk. The mother stopped taking the supplement, and the milk returned to its normal appearance 3 days later. This report should alert physicians to include supplement intake as part of the anamnesis for new mothers who present with breast milk changes.

引言

母乳是新生儿良好的营养来源。母乳喂养有助于儿童的最佳生长和发育，降低了早期感染的风险1。此外，母乳喂养还可以促进母婴之间的联系，这对儿童的健康心理发育具有重要意义。因此，母乳外观的变化会引起母亲和医生的担忧。文献中已经描述了血染、蓝色、蓝绿色和绿色母乳的情况2-6。作者报告了一例因在分娩前和分娩后摄入蓝藻引起的绿色母乳的案例。

Introduction

Breast milk is an excellent source of nutrition for newborns. It has well-recognized benets for optimal growth and development and reduces the risk of infection in early life.1 In addition, the act of breastfeeding induces mother–child bonding, which has important implications for the child’s healthy psychological development. Therefore, a change in the appearance of the breast milk may be alarming to both the mother and health care professionals. Cases of blood-stained, blue, bluish-green, and green breast milk have been described in the literature.2–6 We present the rst case of green breast milk caused by ingestion of blue-green algae in the days before and after delivery.

病例介绍

Case Presentation

38岁女性，孕3，产2，在怀孕35周时生下了健康的双胞胎，出生体重分别为1813g和1920g，两位年长儿完全正常，一直母乳喂养到4个月大。

A healthy 38-year-oldwoman,gravida3, para 2,gave birth to healthy twins at 35 weeks’ gestation. Birth weights were 1,813 and 1,920g. Two older children were completely normal and had been breastfed until age 4 months.

在本次分娩的第二天，母亲分泌30毫升深绿色母乳（图1）。婴儿停用母乳，喂以配方奶。在接受问诊时，这位母亲透露，在分娩前3天，她根据家人的建议，服用含有蓝绿藻复合物（蓝绿藻、小球藻和螺旋藻；以色列安布罗西亚Supherb有限公司）代替了常规的铁补充剂，每天服用750毫克。直到双胞胎出生后的第二天，她一直服用该药。

On the second day after the present delivery, the mother expressed 30mL of dark green breast milk (Fig. 1). The babies were taken off breast milk and given formula feeds. On questioning, the mother revealed that 3 days before giving birth she had replaced her regular iron supplements with capsules containing a blue-green algae complex (blue-green algae, chlorella, and spirulina; Ambrosia-SupHerb Ltd., Israel), 750mg once daily, on the advice of her family. She had continued to take the pills up to the day after the birth of the twins.

这位母亲被要求立即停止服药。Naranjo药物不良反应概率量表评分为5分，表明可能发生药物不良反应。母乳样本被送去进行培养和细胞学检查。细胞学检查未见癌细胞或其他异常，培养阴性。由于没有用额外剂量的藻类进行激发试验，无法测量血中药物水平。

The mother was instructed to immediately stop ingesting the pills. The score on the Naranjo Adverse Drug Reaction Probability Scale was 5, indicating a probable adverse drug reaction, and samples of the breast milk were sent for culture and cytological examination. No cancerous cells or other abnormalities were found on cytological study, and the culture was negative. As we did not perform a challenge with an additional dose of the algae, we could not measure blood levels.

母乳的绿色在接下来的3天里逐渐褪去。到第四天，母乳恢复正常乳白色外观，母亲恢复母乳喂养，母乳颜色没有进一步变化。

The greenish tint of the milk faded gradually for the next 3 days. By the fourth day, the milk returned to its normal creamy-white appearance, and the mother resumed breast- feeding.There was no further change in the color of the breast milk.

图1 深绿色的母乳。前两瓶显示母乳逐渐消失的绿色。最后一瓶母乳呈现出正常的乳白色外观。

FIG. 1. Breastmilk with dark green color. The rst two bottles depict the greenish tint of the milk gradually disappearing. The last bottle shows the normal creamy-white appearance of the milk. 

该乳母同意公布本病例报告和母乳的图像。

Informed consent was obtained from the mother for publication of this case report and the images of the milk.

讨论

初乳的颜色是黄到黄橙色。成熟的母乳最初为蓝白色（前乳），然后变为乳白色（后乳）。母乳颜色的变化归因于食物中的色素、药物或草药的摄入1。有研究报告称，在0.1%的病例中，母乳可能含有血性分泌物，使其变红或变粉，通常在2-5天后消失 2。 Silva等描述了一个病例，其中从乳头流出的血使牛奶变成了铁锈色3。

Discussion

The color of colostrum is yellow to yellow-orange. Mature human breast milk is initially bluish white (foremilk) and then changes to creamy white (hindmilk). Changes in the color of breast milk have been attributed to the consumption of pigments in food and intake of medications or herbal remedies.1 A studyfromour department reported that in 0.1% of cases, the breast milk may contain a bloody discharge, turning it red or pink, which usually clears after 2–5 days.2 Silva et al described a case in which a bloody discharge from the nipple gave the milk the color of a rusty pipe.3

对医学文献的检索发现，绿色母乳罕有报道。在Yazgan等报道一个案例中，牛奶的绿色与摄入多种维生素和矿物质有关，并且需要3周时间使其正常4。Birkholz等报道一例绿乳汁病例，是由于在麻醉过程中输注异丙酚和其他药物所致，先前的研究表明异丙酚的代谢产物可以使患者的尿液变绿5。Di Comite等描述了一名被诊断为杂合子β地中海贫血的孕妇，用铁蛋白治疗几天后，分泌绿乳汁6。实验室分析发现，牛奶含有二价铁。

Our search of the medical literature yielded very few reports of green breast milk. In one case presented by Yazgan et al, the green color of the milk was related to the ingestion of multivitamins and minerals, and it took 3 weeks for the color to normalize. 4 Others described a case of green milk that was attributed to infusion of propofol along with other drugs during anesthesia on the basis of previous studies showing that a metabolite of propofol can turn patients’ urine green.5 Di Comite et al described a pregnant woman diagnosed with heterozygous beta-thalassemia who produced green breast milk for days after treatment with ferritin. 6 On laboratory analysis, the milk was found to contain bivalent iron.

在这个病例，作者认为母乳颜色的变化与该乳母在双胞胎出生前3天到出生后1天每天摄入750毫克蓝藻之间可能存在关系，停用后3天，母乳恢复正常颜色。

In this case, we assumed a possible relationship between the change in color of the mother’s breast milk and her consumption of 750mg/day of blue-green algae from 3 days before the birth of twins until 1 day after. It took 3 days for the milk to return to its normal color after the supplement was stopped.

这是一例引因蓝藻引起母乳颜色变化的报告。这种情况很重要，因为母亲和医生都会发现母乳颜色变化，这会使母乳喂养推迟。应首先通过仔细和全面的询问病史，寻找根本原因。医生应注意，当出现母乳变化时，有必要询问是否摄入营养补充剂。如有疑问，应送母乳样品进行培养和细胞学检查。停止哺乳后，还应对患者进行几天的随访，以确认诊断，并确保母乳在恢复母乳喂养前恢复正常。尽管在该例中，婴儿没有明显的伤害，但我们建议女性最好避免在围产期服用营养补充剂，以避免不必要的麻烦。

This is the rst report of blue-green algae causing a change in the color of breast milk. This case is important as both mothers and medical staff may nd a color change of the breast milk alarming, and it can postpone the start of breastfeeding. The underlying cause should rst be sought by careful and comprehensive history taking. Physicians should be alert to the need to include questions on supplement intake when women present with breast milk changes. In the event of doubt, samples of the milk should be sent for culture and cytological examination. Patients should also be followed up for several days after stopping the supplement to conrm the diagnosis and ensure that the breast milk has returned to normal before breastfeeding is resumed. Although there was no apparent harm to the infants in this case, we suggest that women should probably avoid taking nutritional supplements in the perinatal period to prevent unnecessary distress.

参考文献

References

1. Lawrence RA. Breastfeeding: A Guide to the Medical Profession. 2nd edn. St Louis, MO: C.V. Mosby, 1985, pp. 392–393.

2. Merlob P, Aloni R, Prager H, et al. Blood-stained maternal milk: Prevalence, characteristics and counselling. Eur J Obstet Gynecol Reprod Biol 1990;35:153–157.

3. Silva JR, Carvalho R, Maia C, et al. Rusty pipe syndrome, a cause of bloody nipple discharge: Case report. Breastfeed Med 2014;9:411–412.

4. Yazgan H, Demirdoven M, Yazgan Z, et al. A mother with green breast milk due to multivitamin and mineral intake: A case report. Breastfeed Med 2012;7:310–312.

5. Birkholz T, Eckardt G, Renner S, et al. Green breast milk after propofol administration. Anaesthesiology 2009;111: 1168–1169.

6. Di Comite A, Stante A, Saracino P, et al. [Green milk: A contribution to the study of iatrogenic pollution of human milk?] [in Italian]. Pediatr Med Chir 1985;7:423–427.