HPI ROS PE Test Results GI Case Study

HPI 2 3 4 HPI: Joey is a 4 days old Caucasian male and

1 ROS 3 4 Click Back to Main to go between slides GENERAL –

1 2 PE 4 GENERAL-He is active and alert and quite hungry, he keeps

1 2 3 Tests results Total Bilirubin today is 8 Click on ENTER to

DIFFERENTIAL DIAGNOSIS #1 Benign Neonatal Hyperbilirubinemia #2 Breast Mild Jaundice #3 Gilbert Syndrome And

Benign Neonatal Hyperbilirubinemia Back to main 1 2 3 4 • Pros: – Bilirubin

Breast Mild Jaundice 1 2 3 4 • Pros: – He had jaundice at

Gilbert Syndrome 1 2 • Pros – He had elevated bilirubin at discharge •

What is Most Likely 1 2 Back to main Benign Neonatal Hyperbilirubinemia • More

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HPI ROS PE Test Results GI Case Study

HPI 2 3 4 HPI: Joey is a 4 days old Caucasian male and is exclusively breast feed. His bilirubin when he left the hospital at 48 hours of age was 11 and they recommended frequent feeding and indirect sunlight. Click Back to Main to go between slides CLICK -Back to main

1 ROS 3 4 Click Back to Main to go between slides GENERAL – mother reports he is active and hungry eating every hour HEENT-No reports of coughing Respiratory-no reports of wheezing GI-some spitting up at times Skin-reports some yellowing of skin CLICK -Back to main

1 2 PE 4 GENERAL-He is active and alert and quite hungry, he keeps rooting on his mother's chest during the visit. He has regained ½ of the weight he lost from birth to discharge. HEENT-Normal palate, normal suck reflex, nares are patent Respiratory- Lungs are clear GI- abdomen is soft, normal bowel sounds, stool in diaper Chest – HR is normal rate and rhythm Skin- slight jaundice from nipple down Reflexes- normal root, grasp, and startle reflex Click Back to Main to go between slides CLICK -Back to main

1 2 3 Tests results Total Bilirubin today is 8 Click on ENTER to advance slide

DIFFERENTIAL DIAGNOSIS #1 Benign Neonatal Hyperbilirubinemia #2 Breast Mild Jaundice #3 Gilbert Syndrome And the WINNER IS? ? ? . . .

Benign Neonatal Hyperbilirubinemia Back to main 1 2 3 4 • Pros: – Bilirubin elevated at discharge – He is breast fed exclusively – Bilirubin normalized at day 4 which is on target

Breast Mild Jaundice 1 2 3 4 • Pros: – He had jaundice at discharge – He is breast fed • Cons: – His total bilirubin has normalized at day 4 Back to main

Gilbert Syndrome 1 2 • Pros – He had elevated bilirubin at discharge • Cons- 3 4 – His bilirubin normalized at day 4 Back to main

What is Most Likely 1 2 Back to main Benign Neonatal Hyperbilirubinemia • More common in breast fed babies. Sometimes will require bili-light Peak TB in Caucasian and AA babies is 48 -96 hours and usually is 7 -9. • East Asian infants peak is between 72 -120 hours and usually is 10 to 14. 3 DX Jaundice will typically resolve in three weeks and goes from the face down… you can tell jaundice by blanching the skin. • Breast fed babies may not be getting enough nutrition so be sure and watch the weight. UP TO date is a great resource.