Review Question - QID 104575

The infant in this vignette most likely has breast milk jaundice. No intervention is needed, and the mother does not need to stop breast feeding.

Breast milk jaundice occurs because the infant liver is not mature enough to process lipids. It presents between the 4th and 7th day of life. If breast feeding stops, bilirubin levels fall rapidly; however, if breast feeding continues, bilirubin levels will fall slowly. Distinct from breast milk jaundice, breastfeeding jaundice is the most common cause of neonatal jaundice in the first week of life and occurs in 10% of births. It is characterized by insufficient feeding, which leads to fewer bowel movements and, therefore, decreased bilirubin clearance. The infant in this vignette has been breastfeeding normally.

Moerschel et al. discuss the approach to neonatal jaundice. They suggest the use of a nomogram to determine whether patients should be placed under ultraviolet lights and the appropriate time interval for repeat testing. Total serum bilirubin, risk factors for jaundice, as well as patient age (in hours) are needed to utilize the nomogram.

Maisels et al. discuss phototherapy for treatment of neonatal hyperbilirubinemia. Phototherapy causes bilirubin oxidation and photoisomerization. Oxidized products are excreted in the kidneys, while photoisomers are excreted by the liver.

Incorrect Answers:
Answers 1-3: These interventions are used in other etiologies of neonatal jaundice but not for breast milk jaundice.
Answer 4: While switching to formula may improve the jaundice, mothers should be encouraged to continue breast feeding because of the improved health benefits of breast milk over formula.