An exclusively breastfed, thriving 14-day-old term infant is brought for yellow discoloration. Total serum bilirubin is 11 mg/dL, predominantly indirect, with direct fraction 0.5 mg/dL. Examination and stool color are normal. What is the appropriate advice?
- A Continue exclusive breastfeeding with observation, no interruption of feeds ✓
- B Stop breastfeeding for 48 hours and substitute expressed breast milk dilution
- C Start phototherapy immediately to prevent chronic bilirubin encephalopathy
- D Perform a full sepsis evaluation and begin empirical antibiotics
Correct answer: A. Continue exclusive breastfeeding with observation, no interruption of feeds
Explanation
Breast milk jaundice appears after the first week, peaks around the second week, can persist for weeks, and occurs in a thriving infant with purely unconjugated hyperbilirubinemia. The correct approach is continued breastfeeding with monitoring, because stopping feeds offers marginal bilirubin reduction and disrupts lactation. Phototherapy is guided by threshold charts and is unnecessary at this level in a two-week-old, and a normal examination with pale-stool exclusion argues against cholestasis and sepsis.
Reference: Ghai Essential Pediatrics, 9th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.