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A full term infant with no birth complications and no known risk factors for hyperbilirubinemia complications, discharged early at 36 hours of life, presents to the ED on day of life #4 with jaundice that just started on the day of presentation. Serum bilirubin is 15, all unconjugated. The baby is exclusively breastfed and having 4 wet diapers per day.
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August 6, 2019 at 9:22 am
B) Physiologic jaundice and breastfeeding jaundice, assess PO intake
Physiologic jaundice occurs in the first week of life and is due to immature conjugation processes. Breastfeeding jaundice typically presents on day of life 3-5, and is due to insufficient intake, often seen in exclusively breastfeeding babies whose mothers have not had their milk “come in” yet, or who are having feeding difficulties. Beyond the first few days of life, neonates should have at least 5-6 wet diapers per day. The cause of breast milk jaundice is unknown but is thought to be due to some substance in human breast milk that inhibits conjugation. In a term infant, a bilirubin level up to 15 is unlikely to be due to physiologic jaundice alone, and the fact that it first began on day of life #4 points toward breastfeeding jaundice as well. For a full term infant with no other risk factors, a bilirubin level > 17 necesitates phototherapy (www.bilitool.org). Biliary atresia is associated with elevated conjugated bilirubin, not unconjugated.