Breast Milk Jaundice Clinical Presentation

Updated: Nov 18, 2021
  • Author: Prashant G Deshpande, MD; Chief Editor: Muhammad Aslam, MD  more...
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Physiologic jaundice usually manifests after the first 24 hours of life. This can be accentuated by breastfeeding, which, in the first few days of life, may be associated with suboptimal milk and suboptimal caloric intake, especially if milk production is delayed. This is known as breastfeeding jaundice. Jaundice that manifests before the first 24 hours of life should always be considered pathologic until proven otherwise. In this situation, a full diagnostic workup with emphasis on infection and hemolysis should be undertaken.

True breast milk jaundice (BMJ) manifests after the first 4-7 days of life. A second peak in serum bilirubin level is noted by age 14 days.

In clinical practice, differentiating between physiologic jaundice from breast milk jaundice is important so that the duration of hyperbilirubinemia can be predicted. Identifying the infants who become dehydrated secondary to inadequate breastfeeding is also important. These babies need to be identified early and given breastfeeding support and formula supplementation as necessary. Depending on their serum bilirubin concentration, neonates with hyperbilirubinemia may become sleepy and feed poorly.


Physical Examination

Clinical jaundice is usually first noticed in the sclera and the face. Then, it progresses caudally to reach the abdomen and extremities. Gentle pressure on the skin helps to reveal the extent of the jaundice, especially in darker-skinned babies; however, clinical observation is not an accurate measure of the severity of the hyperbilirubinemia.

A rough correlation is observed between blood levels and the extent of jaundice (face, approximately 5 mg/dL; mid abdomen, approximately 15 mg/dL; soles, 20 mg/dL). Therefore, clinical decisions should always be based on serum bilirubin levels. Skin should have normal perfusion and turgor and show no petechiae.

Neurologic examination findings, including neonatal reflexes, should be normal, although the infant may be sleepy. Muscle tone and reflexes (eg, Moro reflex, grasp, rooting) should be normal.

Evaluate the infant's hydration status by an assessment of the percentage of birth weight that may have been lost, as well as observation of the mucous membranes, fontanelle, and skin turgor.