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Breast Milk Jaundice — RACP Paediatrics MCQ

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HardGastroenterologyBreast Milk JaundiceRACP Paediatrics

A thriving 4-week-old breastfed infant remains jaundiced. Stools are yellow, urine is not dark and examination is normal. Total bilirubin is 165 micromol/L, but it has not yet been fractionated. What is the best next step?

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Correct answer: C — Obtain fractionated bilirubin and the prolonged-jaundice investigation set

Explanation lettering: E = shown as A · D = shown as B · B = shown as C · A = shown as D · C = shown as E

B is correct. Jaundice beyond two weeks is prolonged; breast-milk jaundice is a diagnosis of exclusion after fractionated bilirubin and the recommended haemolysis, thyroid and liver assessment. A normal stool colour lowers but does not abolish cholestasis risk. C interruption of breastfeeding is unnecessary. D this concentration in a well four-week-old does not justify exchange transfusion. E ultrasound follows biochemical evidence or clinical suspicion of cholestasis rather than replacing fractionation.

Reference: RCH Melbourne, Jaundice in early infancy: https://www.rch.org.au/clinicalguide/guideline_index/Jaundice_in_Early_Infancy/