A exclusively breastfed term baby is brought for review at 15 days of life with persistent jaundice. Total serum bilirubin is 11 mg/dL, almost entirely indirect. Weight gain is adequate, stools are yellow, urine does not stain the nappy, and the baby feeds vigorously every 2 to 3 hours. What is the most likely explanation?
- A Biliary atresia
- B Breastfeeding failure jaundice from inadequate intake
- C Breast milk jaundice ✓
- D Galactosaemia
Correct answer: C. Breast milk jaundice
Explanation
Breast milk jaundice appears after the first week, peaks around the second week, and may persist at low levels until 12 weeks while the baby thrives. It reflects enhanced enterohepatic circulation of bilirubin promoted by factors in maternal milk. Breastfeeding failure jaundice occurs earlier, in the first week, and is accompanied by poor weight gain and infrequent stooling, which are absent here. Biliary atresia and galactosaemia produce conjugated hyperbilirubinaemia.
Reference: Nelson Textbook of Pediatrics, 21st ed.
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Written and medically reviewed by the StethoPrep medical team.