Breastmilk Jaundice – Could it be more Common than We Realize?

Introduction: Breastmilk jaundice is a benign often undiagnosed condition, occurring in healthy, term exclusively breastfed neonates. It is characterized by unconjugated hyperbilirubinaemia usually appearing from the second week of life, but sometimes within the first week of life, and persisting for more than two weeks. It’s specific aetiology is multifactorial and remains a topic of debate. Controversies also exist regarding the best treatment option. The American Academy of Paediatricians recommends continuation of breastfeeding with temporary addition of formula.

Aim: This series aims to increase awareness of this condition.

Presentation of Cases: Three cases of unconjugated hyperbilirubinaemia persisting for greater than two weeks, in term, healthy, exclusively breastfed infants in Enugu State, South-East Nigeria are reported. Investigations did not reveal pathological jaundice, and all cases received phototherapy. In the three cases however, the most significant reduction in serum bilirubin occurred after temporary cessation of breastfeeding, with commencement of formula feeds, and subsequent recommencement of breastfeeding.

Discussion: The three cases reported fulfil established criteria for recognizing breastmilk jaundice. This condition is largely underdiagnosed, with no recent reports in literature. The aetiology remains a subject of research. However, several genetic and environmental factors have been suggested. Though the total bilirubin did not reach the American Academy of Paediatrics thresholds for phototherapy in any of the cases, this treatment modality was still used. In addition, in variance to recommendations of the American Academy of Paediatricians, all cases were treated by breastfeeding cessation instead of mixed feeding.

Conclusion: Breastmilk jaundice is largely not remembered as a cause of prolonged jaundice. Its awareness and treatment would greatly reduce both parental anxiety and unnecessary treatment given to babies.