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Phototherapy in Hyperbilirubinemic baby

You are called to see an infant in the newborn nursery. The child was delivered 60 hours prior to your visit. The child appears jaundiced but otherwise healthy. A total serum bilirubin level is measured at 18 mg/dL. Appropriate treatment includes

  • A) observation
  • B) stop breast feeding and switch to formula feedings
  • C) begin phototherapy
  • D) perform a septic workup
  • E) start IV hydration

Answer and Discussion

Hyperbilirubinemia is very common in term newborns. Current recommendations include the following: phototherapy should be instituted when the total serum bilirubin level is >=15 mg/dL (257 آµmol/L) in infants 25 to 48 hours old, 18 mg/dL (308 آµmol / L) in infants 49 to 72 hours old, and 20 mg/dL (342 آµmol/L) in infants older than 72 hours.

It is unlikely that term newborns with hyperbilirubinemia have serious underlying pathology. Physiologic jaundice peaks on the third or fourth day and declines over the first week following birth. Infants who are breast fed are more likely to develop physiologic jaundice because of relative caloric deprivation in the first few days of life. If jaundice occurs in breast-fed infants, feedings should be increased to more than ten times/day.In some cases formula supplementation may be necessary.

Pathologic jaundice occurs if it presents within the first 24 hours after birth, the total serum bilirubin level rises by >5 mg/dL (86 آµmol/L) per day or is >17 mg/dL (290 آµmol/L), or an infant has signs and symptoms suggestive of serious illness. The management consists of excluding pathologic causes of hyperbilirubinemia and initiating treatment to prevent harmful neurotoxicity.The answer is C.

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