Approach to jaundice (newborn and infant) Quiz: Ace Your Exams
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A 3-week-old infant boy is brought to the pediatrician for persistent jaundice. He was delivered at 38 weeks gestational age via spontaneous vaginal delivery after an uncomplicated pregnancy and was discharged home at 24 hours of age. Other maternal labs were normal. The patient has been breastfeeding on demand, approximately 20 minutes per side. Meconium was passed within 24 hours of delivery. Stools have transitioned since then and are now pale in color. The infant has no fever, vomiting, diarrhea, bloody stools, seizures, or hypotonia. Temperature is 37° C (98.6° F), pulse is 143/min, respirations are 36/min, blood pressure is 82/49 mm Hg, and oxygen saturation is 99% on room air. Physical examination reveals scleral icterus and jaundice to the umbilicus. The anterior fontanelle is open and flat. No dysmorphic features are noted. Cardiopulmonary exam is normal. The liver is palpated just below the right costal margin. Labs are shown below. Which of the following should be ordered next?
| Laboratory value | Results | Reference range |
| Total bilirubin | 14.8 mg/dL | 0.6-1.4 mg/dL |
| Conjugated bilirubin | 3 mg/dL | 0-0.3 mg/dL |
| Aspartate aminotransferase (AST) | 90 U/L | 22-71 U/L |
| Alanine aminotransferase (ALT) | 72 U/L | 5-45 U/L |
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