A 21-day-old exclusively breastfed term neonate is brought for evaluation of yellow discoloration. He feeds avidly, has regained his birth weight, and passes normal yellow stools. Total serum bilirubin is 9.5 mg/dL, entirely unconjugated. Haemoglobin is 14 g/dL, reticulocyte count is normal, and thyroid function tests are normal. What is the MOST appropriate management?

• A Stop breastfeeding for 48 hours and substitute formula
• B Perform a sepsis screen and start empirical antibiotics
• C Start phototherapy immediately to prevent kernicterus
• D Reassure the mother and continue exclusive breastfeeding with follow-up ✓

Explanation

Breast milk jaundice appears toward the end of the first week, peaks in the second to third week, and may persist for up to 12 weeks as unconjugated hyperbilirubinaemia in a thriving infant. It is a diagnosis of exclusion, so haemolysis, hypothyroidism, and sepsis must be ruled out, as done here. Interruption of breastfeeding is reserved for much higher bilirubin levels when a temporary diagnostic drop is needed. At 9.5 mg/dL on day 21, observation alone is appropriate.

Reference: Nelson Textbook of Pediatrics, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.