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Hyperbili work-up @6wks
You are seeing a 6 week old ex-full term infant who is breastfeeding exclusively, having 6 wet diapers per day, 4 or more soft seedy stools per day, growing well, and no fever. Baby has been jaundiced since 1st week of life, and while it is not worse, parents come in because it is prolonged. Jaundice is to the level of the chest, and transcutaneous bili is 10.
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Kelly April 3, 2017 - 12:42 pm
Breast-feeding jaundice typically occurs age 2-5 days, and is from inadequate breastfeeding (look for 4-6 wet diapers/day for adequate intake). Physiologic jaundice in newborns peaks at age 3-5 days, is not > 12 in term infants, and resolves by 2 weeks. Breast-milk jaundice typically occurs at 4-10 days, is due to an unknown factor in breastmilk interfering with conjugation / excretion of bilirubin, and can last 8-12 weeks. Prolonged jaundice when still in the < 12 week age group can be attributed to exclusive breastfeeding if total bili is < 12 and direct bili is < 1 or 8-10 days of age), etc. So, a CBC, T&S/Coomb’s, UA would be recommended by some, and definitely should be done if bili is > 12, rising, or baby is not exclusively breastfed. Recommendations are to obtain serum bili when TcB is 70-75% of the concerning serum bili value (75% of 12 is 9). Jaundice at > 12 weeks should not be attributed to breast milk jaundice alone.