A healthy exclusively breastfed term neonate is noted to be mildly jaundiced at 3 weeks of life. Total serum bilirubin is 9 mg/dL, entirely unconjugated. The baby feeds well, gains weight normally, stool colour is yellow, and hemoglobin and reticulocyte count are normal. Coombs test is negative. What is the most likely cause?

• A Biliary atresia
• B Hereditary spherocytosis
• C Hypothyroidism
• D Breast milk jaundice ✓

Explanation

Breast milk jaundice appears after the first week, peaks around 2 weeks, and may persist at low unconjugated levels for up to 12 weeks in a thriving infant. It is a diagnosis of exclusion requiring normal conjugated fraction, normal hemolysis markers, negative Coombs test and pigmented stools, all satisfied here. Biliary atresia produces conjugated hyperbilirubinemia with acholic stools, and hereditary spherocytosis would show anemia with elevated reticulocytes.

Reference: Nelson Textbook of Pediatrics, 21st ed.

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Written and medically reviewed by the StethoPrep medical team.