A 20-day-old exclusively breastfed term neonate is brought for yellow discoloration. He feeds well, passes normal coloured stools and urine, and gains weight appropriately. Total serum bilirubin is 11.5 mg/dL, almost entirely indirect, and hemolysis screen is negative. What is the MOST likely diagnosis?
- A Breastfeeding (starvation) jaundice
- B Congenital hypothyroidism
- C Breast milk jaundice ✓
- D Galactosaemia
Correct answer: C. Breast milk jaundice
Explanation
Breast milk jaundice appears after the first week, typically peaks around the second to third week, and may persist at modest unconjugated levels for up to 12 weeks while the baby thrives normally. Breastfeeding or starvation jaundice occurs in the first week and reflects poor intake with infrequent stools. Normal stool colour excludes cholestatic causes such as galactosaemia and biliary atresia, and a thriving baby with negative haemolysis screen supports this benign diagnosis.
Reference: Nelson Textbook of Pediatrics, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.