From the Research
To diagnose breastfeeding jaundice in a 1-month-old infant, you should observe a significant decrease in bilirubin levels within 24-48 hours after temporarily stopping breastfeeding, with a reduction of at least 2-3 mg/dL (34-51 μmol/L) suggesting breastfeeding jaundice as the cause. This is based on the most recent and highest quality study available, which emphasizes the importance of evaluating newborns for risk factors for bilirubin-related neurotoxicity and obtaining screening bilirubin levels in those with risk factors 1.
Key Considerations
- Breast milk jaundice typically peaks at 10-15 mg/dL and gradually resolves by 3-12 weeks of age, and is generally benign and resolves spontaneously without intervention 1.
- Certain substances in breast milk can inhibit bilirubin metabolism in the liver or increase intestinal reabsorption of bilirubin, leading to breast milk jaundice 2.
- The American Academy of Pediatrics recommends universal neonatal hyperbilirubinemia screening in newborns 35 weeks' gestational age or greater, but notes that universal screening may increase unnecessary phototherapy use without sufficient evidence that it decreases the incidence of kernicterus 1.
- Phototherapy should be used only for newborns who exceed thresholds recommended by the current AAP hour-specific phototherapy nomograms, and mothers of infants who develop jaundice are more likely to stop breastfeeding, even though discontinuation is not necessary 1.
Diagnostic Approach
- Evaluate all newborns for risk factors for bilirubin-related neurotoxicity, and obtain screening bilirubin levels in those with risk factors 1.
- Examine all newborns regularly, and measure bilirubin levels in those who appear jaundiced 3.
- If bilirubin levels remain elevated despite interrupting breastfeeding, other causes of prolonged jaundice should be investigated 2.
Management
- Continue breastfeeding while monitoring bilirubin levels, as breast milk jaundice is generally benign and resolves spontaneously without intervention 1.
- Use phototherapy only for newborns who exceed thresholds recommended by the current AAP hour-specific phototherapy nomograms, and be aware of the potential for short- and long-term adverse effects 1.