Approach to jaundice (newborn and infant) Quiz: Ace Your Exams
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A 5-day-old female neonate is brought to the clinic for worsening jaundice. She was delivered at 37 weeks' gestation following an uncomplicated pregnancy and delivery. Birth weight was 3400 grams. The infant initially had difficulty latching but subsequently appeared to nurse adequately, and she was discharged home after two days of life. The mother reports she has not been nursing well and has become increasingly sleepy with less frequent wet diapers and stools. There have been three wet diapers in the last 24 hours. She has not had vomiting, diarrhea, bloody stools, or seizures. Temperature is 37° C (98.6° F), pulse is 171/min, respirations are 32/min, blood pressure is 74/46 mm Hg, and oxygen saturation is 97% on room air. Current weight is 3000 grams. Examination reveals scleral icterus, jaundice to the umbilicus, and dry mucous membranes. The anterior fontanelle is open and mildly sunken. There are no dysmorphic features. Cardiac exam is significant for tachycardic and a flow murmur. Respiratory and abdominal exams are normal. Labs are shown below. Which of the following is the best next step in management?
| Laboratory value | Results |
| Total bilirubin | 15 mg/dL |
| Conjugated bilirubin | 1 mg/dL |
| Aspartate aminotransferase (AST) | 50 U/L |
| Alanine aminotransferase (ALT) | 25 U/L |
| Reticulocytes | 0.7% |
| Direct antiglobulin test (DAT) | Negative |
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