![]() The infant remains on phototherapy for an additional 2 days and is discharged home after being off phototherapy for 1 day. The decision is made to perform a double volume exchange transfusion. After 12 hours of phototherapy, a repeat bilirubin is 25 mg%. The hematocrit is 42% with a reticulocyte count of 12% and the pathologist identifies spherocytes on the blood smear. His blood type is A+ with a positive direct Coombs. He is admitted to the hospital where phototherapy is initiated. The total bilirubin is 27 mg% with a direct fraction of 1 mg%. Other physical exam findings are remarkable for a normal cry, flat anterior fontanelle, moist oral mucosa and a normal neurologic examination. He is markedly jaundiced and has a resolving cephalohematoma. At today's visit there is an 8% weight loss from birth and a history of "fair" urine output and yellow stools. At the time of discharge, his physical exam was remarkable for mild jaundice and a cephalohematoma. He was discharged home on day 2 of life after successfully breastfeeding for a 24 hour period. She baby is scheduled for follow-up with both the pediatrician and the lactation consultant.Ī 4 day old, 36 week gestation male presents to his primary care physician with worsening jaundice. By the following day, the bilirubin has decreased to 12 mg% and she is discharged home on breast milk feedings. She is admitted to the hospital for phototherapy, supplementary formula feedings, and lactation consultation. The total bilirubin is 20 mg% with a direct fraction of 0.7 mg%. The remainder of the physical exam is normal. No cephalohematoma or bruising is present. The anterior fontanel is slightly sunken, the oral mucosa is tacky, and there is jaundice to the lower extremities. Weight 2.7 kg (25%ile), length 50 cm (75%ile), head circumference 34 cm (75%ile). The urine is described as dark yellow in color and the stools appear dark green.Įxam: VS T 37.8, P 162, RR 55, BP 63/45. In the office, on day 4, mother reports that she is breastfeeding the baby every three hours and that there have been 2 wet diapers per day. They also had an appointment to see their pediatrician the following day. In addition, they noted an increase in the degree of jaundice, but failed to address it after being reassured by family members that jaundice is common. On day 3, her parents gave her water on two occasions as she appeared hungry despite regular and frequent breast feeding attempts. In the hospital, she was breast fed every 3 hours and had 2 wet diapers and one meconium stool over a 24 hour period. The baby was discharged home on day of life 2 at which time her weight was down 4% from birth weight and she had mild facial jaundice. This is a jaundiced, 4 day old, 3.1 kg, appropriate for gestational age (AGA) Asian female infant born at term to a 25 year old A+ primiparous woman with gestational diabetes. Case Based Pediatrics Chapter Case Based Pediatrics For Medical Students and Residentsĭepartment of Pediatrics, University of Hawaii John A.
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