Breast Milk Jaundice

Jaundice, also known as hyperbilirubinemia, is a frequently encountered clinical problem in neonates. About 60-80% of all term or late-term healthy newborns will develop some degree of hyperbilirubinemia. The 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. 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. The two common mechanisms for this are “breastfeeding jaundice” and “breast milk jaundice.” See Bilirubin Metabolism and Suggested Mechanisms of Breast Milk Jaundice. Breast milk jaundice was first described in 1963. Arias et al. noted that some breastfed infants had 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. Infants with breast milk jaundice often have higher serum bilirubin peaks and slower decline, compared to the hyperbilirubinemia trend associated with other etiologies, leading to a longer resolution time. Pathological causes of unconjugated hyperbilirubinemia should be ruled out before a breast milk jaundice diagnosis can be made.