Breast milk jaundice is a form of late-onset neonatal jaundice; it is known to occur in as many as one-third of all healthy breastfed newborns. The underlying etiology is unknown; it is postulated that certain substances in the maternal milk (e.g. β-glucuronidases, and nonesterified fatty acids) inhibit the normal metabolism of bilirubin, resulting in indirect hyperbilirubinemia. In these children, bilirubin levels typically peak between the 6th to 14th days of life; they usually decline rapidly afterwards, but may remain elevated for as long as one to three months. Breast milk jaundice is self-limiting; no treatment is usually required. If serum bilirubin levels increase to >20 mg/dL, breastfeeding may be temporarily interrupted and formula feeds started. This typically causes a rapid reduction in bilirubin levels, allowing for breastfeeding to be started
Breastfeeding jaundice is a form of early-onset exaggerated physiologic jaundice; it is believed to be a consequence of insufficient breast milk intake. An insufficient frequency and volume of feedings results in delayed passage of meconium, and correspondingly, increased enterohepatic circulation of bilirubin. Treatment is via increasing the number of feeds to 10 or more per day. If the neonate still demonstrates poor stooling, formula supplementation may also become necessary.
Physiological jaundice is the most common form of neonatal jaundice, occurring in healthy term newborns. This is believed to be caused by a variety of factors, including an increased bilirubin load because of relative polycythemia and a shortened erythrocyte life span (vis-a-vis adults); immature hepatic uptake and conjugation processes; and, increased enterohepatic circulation of bilirubin. In these infants, jaundice first occurs between 24 to 72 hours after birth, with bilirubin levels peaking around the 4th to 5th day, and normalizing by the 10th to 14th day of life. Physiological jaundice is usually self-limiting; however, if bilirubin levels exceed 15 mg/dL, phototherapy should be considered.