A 4-week, full term girl presents to the NICU for jaundice present since 1 week of age and increasing head circumference for over a week. She was born after an uneventful 41-week pregnancy. Family history was significant for Gilbert disease in the father. She has been exclusively breastfed since birth. At 2 weeks of age, she was seen in the emergency department for vomiting after each feeding and jaundice. An abdominal ultrasound showed no evidence of pyloric stenosis; treatment with ranitidine was initiated for suspected gastroesophageal reflux disease. Her clinical jaundice was attributed to breastmilk, and no further laboratory evaluation was completed. At 4 weeks of age, her mother brought the infant to the referring hospital for evaluation of persistent jaundice, increasing head circumference, frequent bruising, and epistaxis. It was confirmed that her head circumference had increased from 33.5 cm (14.5%) at birth to 42 cm (99%) at 4 weeks...

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