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11 Cards in this Set
- Front
- Back
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A 4-day-old baby boy presents for his first pediatric well child visit. His birth history consists of an uncomplicated normal spontaneous vaginal delivery after 7 hours of labor—no vacuum or forceps assistance were used. The patient is the first child to a 30-year-old mother of Mediterranean descent. Mom is very concerned that her baby has started to look “yellow” since leaving the hospital. She has been breastfeeding every 2–3 hours and says that the baby latches on for 1–5 minutes for each feed. He has had few wet diapers, and mom is concerned he is not getting enough to eat. Which of the following would most aid in narrowing the differential diagnoses?
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Fractionated bilirubin: TSB and direct serum bilirubin |
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A concerned mother brings her 7-day-old son to your office after noticing yellowing of his skin for 2 days. She has also noticed he has not been gaining weight since she brought him home from the hospital 5 days ago. This is her first son and she has been trying to do everything perfectly, including breastfeeding him, since she was told that breast milk provides adequate nutrients and other healthy benefits, like antibodies and growth factors. However, upon further questioning, she is feeding him only 6 times a day for 10 minutes each time. She admits her breasts often feel full and are not relieved by nursing. He was born full term by spontaneous vaginal delivery but had a hard time sucking with breastfeeding. Upon exam, he looks dehydrated and appears to have jaundice of the face and chest. He has also lost > 10% of his birth weight. What could be the cause of his jaundice?
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Breastfeeding jaundice |
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Breast milk jaundice |
cause of jaundice associated with breastfeeding occurs if: infant feeding well |
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Physiologic jaundice |
peaks at 3-4 days of life full term, healthy infants increased br production from short lived RBCs lack of intestinal flora no treatment, self resolving |
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Sepsis |
clinically sick toxic jaundice would be just one sign of serious infection respiratory distress, lethargy, poor feeds, vomiting, apnea, temperature instability breast feeding can have some protection |
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breastfeeding jaundice |
first week of life poor breast milk intake limited enteral intake and increased enterohepatic circulation |
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Criglar-Najjar syndrome |
first days of life persists rare absent UDPGT |
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A 5-day-old infant presents with a chief complaint of jaundice. As you obtain a careful history and physical examination, which of the following would NOT be a risk factor for jaundice in this infant?
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PKU |
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Risk factors for jaundice of newborn |
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Difficult deliveries and jaundice |
may result in cephalohematomas or hemorrhage of blood between skull and periosteum breakdown of RBCs from hematoma can result in increased BR levels |
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A 3-week-old baby boy is brought to his pediatrician with a chief complaint of light tan–colored stools and worsening jaundice. His is exclusively breastfed and has 6–8 wet diapers per day. On exam, he appears to have scleral icterus and jaundice. Upon further workup, he is found to have an elevated direct bilirubin. What is his most likely diagnosis?
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Biliary atresia: occurs after 2 weeks
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