Witch's milk or neonatal milk is milk secreted from the breasts of some newborn human infants of either sex. Production of neonatal milk by infants usually resolves itself and does not require treatment unless it is caused by an underlying condition or medications. It is thought to be caused by the exposure to an elevated level of estrogen to infants during pregnancy or decreased exposure of estrogen to infants after birth. Its production also may be caused by certain medications. The composition of neonatal milk is similar to maternal milk for most of their components except for fats and one type of antibody. Neonatal milk production occurs in about 6% of newborns with age from 0 to 12 weeks. Within the age range, infants age 0 to 2 weeks were found to have the highest occurrence. Compared to those who did not have neonatal milk production, infants who did had larger breast nodules. Pre-term infants under the gestational age of 34 weeks did not secrete milk as observed in one study. Complications such as mastitis and abscesses are associated with breast massage of the neonate's breast. Squeezing of neonate's breast could also result in an infection. Blood from the nipples is nearly always benign and frequently associated with duct ectasia; it should only be investigated when it is unilateral. The name witch's milk originates from ancient folklore and is associated with religious and cultural interpretations.
Lactation physiology The hormone prolactin has a key role in lactation and breast development in the human body and it is also a functional component of homeostasis. It has varying originations including the central nervous system (CNS), the immune system, mammary glands, and uterus. Development and introduction of any of the following contributes to its production as well: thyrotropin releasing hormone (TRH), estrogen, and dopamine antagonists. However, the pituitary gland is a primary source for the synthesis and secretion of prolactin. Prolactin's primary functions are breast milk production and mammary gland development. Prolactin has a stimulating effect on alveoli within the mammary glands causing the production of milk that consists of lactose, casein, and lipids. The anterior region of the pituitary gland, more specifically, houses an increasingly abundant number of lactotrophs (stimulated within the physiology of pregnancy) that synthesize prolactin for secretion. The rise of lactotroph proliferation is attributed to growing estrogen levels within a pregnant individual. Connecting to the pituitary gland via the infundibular stalk, is the hypothalamus of which is the primary regulator of prolactin production. The dopamine the hypothalamus releases has an inhibitory effect on lactotrophs, controlling its prolactin secretion. The serum levels of prolactin are typically low in males and non-lactating females, inhibiting possibility for breastmilk production. In the cases that the serum levels of prolactin do become high in these individuals, the phenomenon galactorrhea is to occur.
Witch's milk pathophysiology
Hyperprolactinemia Witch's milk, or neonatal galactorrhea, in newborns is primarily caused by hyperprolactinemia - abnormally high level of prolactin hormone. Please note that galactorrhea and hyperprolactinemia physiologies are independent of one another. There are currently two different mechanisms described in literatures explaining the cause of hyperprolactinemia in neonates. One mechanism states that hyperprolactinemia in neonates results from the decline of maternally transferred estrogen after birth. Decreased estrogen increases production of prolactin which increases milk production. The other mechanism states that hyperprolactinemia in neonates after birth results from their exposure to high maternally transferred estrogen level during pregnancy.
Prolactin In breastfeeding, pituitary hormone prolactin vary throughout pregnancy and in different lactation conditions. Prolactin, produced by the pituitary gland, is essential for initiating and maintaining milk production. Its levels increase during pregnancy to prepare the breasts for milk production and remain high after childbirth to continue supporting breastfeeding. Issues related to abnormal lactation, such as inadequate milk supply or galactorrhea, an excessive milk flow not linked to childbirth, are also explored. Fluctuations in prolactin levels can significantly influence these problems. By analyzing prolactin levels in various lactation situations, insights are provided into how changes in prolactin affect milk production and overall lactation health. This emphasizes the importance of understanding prolactin's role for better diagnosis and management of lactation issues, offering valuable information for treating both normal and problematic lactation cases.
Medications Medications are a significant cause of hyperprolactinemia and galactorrhea. They can disrupt the normal regulation of prolactin by either inhibiting dopamine, which naturally suppresses prolactin secretion, or by directly stimulating the release of prolactin. Opiates are among these medications. They can elevate prolactin levels by inhibiting dopamine release, reducing the dopamine-mediated suppression of prolactin, thus leading to increased prolactin levels and possibly causing galactorrhea. The use of opiates by mothers during pregnancy or breastfeeding can transfer these drugs to the infant, potentially leading to neonatal galactorrhea, also known as "witch's milk."
Prolactinoma A tumor originating in the pituitary gland is one cause of galactorrhea. This pituitary tumor, prolactinoma, results in an overproduction of prolactin, or hyperprolactinemia. This type of cause is classified under organic hyperprolactinemia. In pregnancy, the lactotroph production increases through means of cellular proliferation of which gives rise to potential for neoplastic development. This is especially true in cases where this proliferation becomes uncontrollable. In patients of varying ages who present with hyperprolactinemia, 12-70% of them have been diagnosed with prolactinoma.
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