A healthy exclusively breastfed term neonate presents at 18 days of life with jaundice. Total serum bilirubin is 11 mg/dL, entirely unconjugated. The baby feeds well, passes pale yellow stools, has normal urine color, and weight gain is adequate. Hemogram and reticulocyte count are normal. What is the MOST likely diagnosis?

• A Breastfeeding (starvation) jaundice
• B Galactosemia
• C Hypothyroidism
• D Breast milk jaundice ✓

Explanation

Breast milk jaundice appears after the first week, peaks around the second week, and may persist for up to three months while the baby thrives. It is attributed to factors in breast milk that enhance enterohepatic circulation of bilirubin. Breastfeeding or starvation jaundice occurs earlier, in the first week, from inadequate intake and dehydration. Galactosemia causes vomiting, hepatomegaly, and reducing substances in urine rather than isolated well-baby jaundice.

Reference: Nelson Textbook of Pediatrics, 21st ed.

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Written and medically reviewed by the StethoPrep medical team.