A full-term neonate at 36 hours of life has a total bilirubin of 18 mg/dL. The baby is on breastfeeding. Direct Coombs test is negative. Reticulocyte count is normal. The most likely diagnosis and the correct next step is:

• A Breast milk jaundice — advise temporary cessation of breastfeeding for 48 hours
• B ABO hemolytic disease — start immediate exchange transfusion
• C G6PD deficiency — screen and avoid oxidant drugs
• D Breastfeeding failure jaundice — optimize breastfeeding and supplement with formula; phototherapy if bilirubin at or above threshold ✓

Explanation

Breastfeeding failure jaundice (early-onset, first week) is caused by inadequate intake leading to dehydration and increased enterohepatic circulation. It peaks earlier (day 2–4) than breast milk jaundice (peak day 10–14). The negative Coombs and normal reticulocyte count exclude hemolytic causes. Management involves optimizing breastfeeding, ensuring adequate intake, and applying phototherapy if the bilirubin reaches age-specific thresholds per Bhutani nomogram. Breast milk jaundice is a late phenomenon and temporary cessation is rarely recommended.

Reference: Ghai Essential Pediatrics, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.