Breast milk jaundice
Newborns produce bilirubin at a rate that exceeds adults due to the relative polycythemia and increased RBC turnover.. 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.
The etiology is unknown but may be related to inflammatory cytokines in human milk and the presence epidermal growth factor.
- Jaundice within the first 4-7 days of life
- 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)
- Gartner LM, Herschel M. Jaundice and breast-feeding. Pediatr Clin North Am. 2001;48:389–99.
- Gotze T et al. Neonatal cholestasis - differential diagnoses, current diagnostic procedures, and treatment. Front Pediatr. 2015. 3:43