A 2-week-old newborn presents with mild jaundice that had begun 6 days ago. The baby was born full-term following a normal pregnancy and uncomplicated birth. Her birth weight was 3... A 2-week-old newborn presents with mild jaundice that had begun 6 days ago. The baby was born full-term following a normal pregnancy and uncomplicated birth. Her birth weight was 3.45 kg. The girl is exclusively breastfed and gaining weight properly. No pathologic findings are evident on physical examination. Ultrasound examination of liver and biliary systems is normal. Result: Indirect bilirubin 2019 mol/L, Direct bilirubin 1 <10 moll, Alanine aminotransferase 25.8 13-45 U/L, Aspartate aminotransferase 23.7 12-40 U/L. Which of the following is most appropriate initial management? A. Observation B. Phototherapy C. Exchange transfusion D. Phenobarbital treatment
Understand the Problem
The question describes a 2-week-old newborn presenting with mild jaundice that began 6 days ago. The baby was born full-term with a normal pregnancy and birth, is exclusively breastfed, and gaining weight properly. Physical examination and ultrasound are normal, with elevated indirect bilirubin but normal direct bilirubin and liver enzymes. The question asks you to select the most appropriate initial management.
Answer
Observation
The most appropriate initial management is observation.
Answer for screen readers
The most appropriate initial management is observation.
More Information
Given the baby is full-term, gaining weight appropriately with exclusive breastfeeding, has normal liver and biliary system ultrasound, and normal liver enzyme levels, the jaundice is likely physiological or breast milk jaundice. A bilirubin level of 2019 mol/L should read 20.19 mg/dL, which, while elevated, may not require immediate intervention in a healthy, full-term infant beyond observation and continued breastfeeding support. If the jaundice worsens or bilirubin levels continue to rise, phototherapy may become necessary.
Tips
A common mistake is to immediately opt for phototherapy without considering the overall clinical picture and the likely etiology of the jaundice.
Sources
- Infant jaundice - Symptoms & causes - Mayo Clinic - mayoclinic.org
- Jaundice in Newborns: Symptoms, Causes & Treatment - my.clevelandclinic.org
- Breast Milk Jaundice (Nursing) - StatPearls - NCBI Bookshelf - ncbi.nlm.nih.gov
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