An exclusively breastfed term infant is seen at 3 weeks of age with unconjugated hyperbilirubinaemia of 11 mg/dL. The baby feeds well, gains weight, has pigmented stools, and haemolysis workup is negative. Which pattern is MOST characteristic of breast milk jaundice?
- A Peak between the second week of life with persistence up to 12 weeks ✓
- B Onset within the first 24 hours with rapid rise above 15 mg/dL
- C Rapid fall to normal within 48 hours of stopping feeds permanently
- D Associated with a direct bilirubin fraction exceeding 2 mg/dL
Correct answer: A. Peak between the second week of life with persistence up to 12 weeks
Explanation
Breast milk jaundice appears after the first week, peaks around the second week, and may persist at low levels for up to 12 weeks while the baby thrives. It is a diagnosis of exclusion after ruling out haemolysis, hypothyroidism and cholestasis. Jaundice in the first 24 hours is always pathological, interruption of breastfeeding lowers bilirubin temporarily with rebound on resumption, and the direct fraction remains normal.
Reference: Nelson Textbook of Pediatrics, 21st ed.
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