A 4-day-old term breastfed neonate has serum bilirubin of 18 mg/dL. He is feeding well, urine is yellow, stool is yellow. Coombs test is negative. What is the most likely cause and initial management?

• A ABO haemolytic disease — exchange transfusion
• B Physiological neonatal jaundice — reassurance and ensure adequate breastfeeding
• C Breast milk jaundice — temporary cessation of breastfeeding and formula feeding
• D Breastfeeding jaundice — increase feeding frequency and evaluate for supplementation if needed ✓

Explanation

Breastfeeding jaundice (also called breast-non-feeding jaundice) occurs in the first week of life due to insufficient milk intake, caloric deprivation, and increased enterohepatic circulation of bilirubin. It peaks by days 3–5. The correct management is to increase breastfeeding frequency (at least 8–12 feeds per 24 hours), evaluate latch, and if hyperbilirubinemia is significant, supplement with expressed breast milk or formula. Breast milk jaundice is a distinct entity persisting beyond 2 weeks due to beta-glucuronidase in breast milk; temporary cessation is sometimes used diagnostically. Phototherapy is indicated based on hour-specific bilirubin nomograms; at 18 mg/dL on day 4 in a term infant, phototherapy would likely be required.

Reference: Ghai Essential Pediatrics, 10th ed.

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Written and medically reviewed by the StethoPrep medical team.