The parents of a full-term (38 3/7 weeks) baby boy born three days ago bring him to the ED because he “looks yellow”; the family was to see the baby’s pediatrician today for a recheck, but was unable due to the office’s schedule. The child has been doing well at home, with normal urine output and without fever or difficulty with feeds; this is their first child. Mother began to breastfeed in hospital, but was discouraged by her family members when she arrived home; the child has been formula-fed for the past day.
In the ED, you see a well appearing African-American baby boy with normal vital signs and a normal head-to-toe newborn exam; he has yellow palms. There is no family history of metabolic syndrome or blood dyscrasia.
You decide to check his total bilirubin level, which results at 11 mg/dL. The parents are concerned, especially the father, who recently had routine blood tests with a total bilirubin of 0.8 mg/dL –“my son has a level 10 times higher than me – and he’s so little!”. Regarding the management of your patient, which of the following is the single BEST answer:
A. Observe the child in the ED and recheck his total bilirubin in 2-4 hours
B. Give IV fluids and consider phototherapy
C. Ask the mother what time of the day the child was born
D. Admit the child for further workup
In the meantime, a quote: "An observant parent's evidence may be disproved but should never be ignored." --Anonymous Lancet 1:688, 1951
In the ED, you see a well appearing African-American baby boy with normal vital signs and a normal head-to-toe newborn exam; he has yellow palms. There is no family history of metabolic syndrome or blood dyscrasia.
You decide to check his total bilirubin level, which results at 11 mg/dL. The parents are concerned, especially the father, who recently had routine blood tests with a total bilirubin of 0.8 mg/dL –“my son has a level 10 times higher than me – and he’s so little!”. Regarding the management of your patient, which of the following is the single BEST answer:
A. Observe the child in the ED and recheck his total bilirubin in 2-4 hours
B. Give IV fluids and consider phototherapy
C. Ask the mother what time of the day the child was born
D. Admit the child for further workup
In the meantime, a quote: "An observant parent's evidence may be disproved but should never be ignored." --Anonymous Lancet 1:688, 1951
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