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

  • The most important component of the workup is differention of direct vs indirect bilirubinemia
  • See BiliTool and the phototherapy guide for total bilirubin cutoff by age recommendations
  • History extremely important
    • 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?)
  • Total bilirubin/Direct bilirubin levels
  • CBC (for evaluation of hemolytic anemia or polycythemia vera)
  • Consider coombs or T&S (mom & baby)

Management

Disposition

See Also

External Links

References

  1. Gartner LM, Herschel M. Jaundice and breast-feeding. Pediatr Clin North Am. 2001;48:389–99.
  2. Gotze T et al. Neonatal cholestasis - differential diagnoses, current diagnostic procedures, and treatment. Front Pediatr. 2015. 3:43