Breast Milk Jaundice

Jaundice, also known as hyperbilirubinemia, is a frequently encountered clinical problem in newborns. Estimates are that between 60-80% of all term or late-term, healthy newborns exhibit idiopathic jaundice.[1] Ther definition of neonatal hyperbilirubinemia has typically been total serum bilirubin (TSB) levels within the high-risk zone, or greater than the 95th percentile for age within the first six days of life.[1] When total serum bilirubin levels rise, a yellowish discoloration of the infant's skin and sclera occurs and is referred to as jaundice. Neonatal hyperbilirubinemia has a higher frequency in breastfed infants compared to formula-fed infants.[2] The two common mechanisms for this are "breastfeeding jaundice" and "breast milk jaundice." Breast milk jaundice was first described in 1963 when it was noted that some breastfed infants had prolonged, unconjugated hyperbilirubinemia that persisted beyond the third week of life. Breast milk jaundice typically presents in the first or second week of life and usually spontaneously resolves even without discontinuation of breastfeeding. However, it can persist for 8-12 weeks of life before resolution.[2] Infants with breast milk jaundice often have higher peaks of serum bilirubin and an overall slower decline than infants without it, leading to the longer resolution time[3] Usually pathologic causes of persistent, unconjugated hyperbilirubinemia are ruled out before a diagnosis of breast milk jaundice can be made.