II. Pathophysiology
- Early Breast Milk Jaundice
- Same as mechanism as exaggerated physiologic Jaundice
- Related to initial decreased calorie intake
- Late Breast Milk Jaundice
- Nonesterified long-chain Fatty Acids in Breast Milk
- Competitively inhibit glucuronyl transferase
III. Labs
- See Neonatal Bilirubin
- Early-Onset Breast Milk Jaundice
- Same course as exaggerated physiologic Jaundice
- Total Bilirubin peaks < 17 mg/dl by day 4 of life
- Late-Onset Breast Milk Jaundice
- Bilirubin peaks between day of life 6 to 14
- Total Bilirubin often 12 to 20 mg/dl
- Hyperbilirubinemia may persist 2-3 months
IV. Differential Diagnosis
V. Management: Early onset Breast Feeding Jaundice
- Encourage mothers to nurse frequently (8-10x per day)
- Avoid supplementation if possible
- Do not supplement with Glucose or sterile water
- Continue Breast Feeding even if supplementing
- Formula indicated for inadequate milk production
- Poor weight gain
- Delayed stooling (and delayed transition to seedy mustard-colored stools by day 3-4 of life)
- Less than 4 wet diapers daily
- Monitor Serum Bilirubin daily as outpatient
- See Phototherapy Indications
- Mothers may express milk after feedings
- Increases milk volume
VI. Management: Late onset Jaundice (Bilirubin 17-20 mg/dl)
- Diagnosis
- Interrupt Breast Feeding for 24-48 hours
- Express milk regularly to maintain production
- Monitor Serum Bilirubin levels every 12-24 hours
- Anticipate Bilirubin decrease of 3 mg/dl per day
- Resume Breast Feeding after decreased Serum Bilirubin
- Confirms Breast Feeding Jaundice