Breast milk jaundice
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Background
Newborns produce bilirubin at a rate that exceeds adults due to the relative polycythemia and increased RBC turnover.[1]. Breastmilk jaundice is an indirect hyperbilirubinemia in breastfed newborn that develops within the first 4-7 days of life. It does not generally cause kernicterus.
Cause
The etiology is unknown but may be related to inflammatory cytokines in human milk and the presence epidermal growth factor.[2]
Clinical Features
- Jaundice within the first 4-7 days of life
Differential Diagnosis
Evaluation
Neonatal jaundice workup
The most important component of the workup is differention of direct vs indirect bilirubinemia
- Total and direct bilirubin levels ("neonatal bilirubin")
- CBC (for evaluation of hemolytic anemia or polycythemia vera)
- Consider coombs or T&S (mom & baby)
Neonatal jaundice diagnosis
- Determine if there are red flags or obvious diagnosis based on history and exam
- Mother's blood type (important if mother is RH negative or O blood type)
- Assess for any signs of decreasing oral intake or signs of dehydration?
- Baby's general appearance (well appearing? evidence of sepsis?)
- Determine bilirubinemia type: direct vs indirect
- Direct
- Admit
- Indirect
- Determine risk category
- See table below
- Determine if patient is above of below bilirubin cutoff by age and risk category
- See table below or use BiliTool or phototherapy guide
- Determine risk category
- Direct