What’s Your Diagnosis? Neonatal Hyperbilirubinemia

Welcome to this month’s What’s Your Diagnosis Challenge!

But before we begin, check to see if you got last Pediatric Electrical Injuries in the Emergency Department right.

Case Presentation: Neonatal Hyperbilirubinemia: Recommendations for Diagnosis and Management in the Emergency Department 

A 4-day-old boy born at 39 weeks’ gestation presents for evaluation of jaundice…  

The jaundice was first noticed 2 days ago. The birth was unremarkable, with a birth weight of 2.4 kg. The baby has been exclusively breast-fed and has 2 wet diapers/day. On examination, the patient has scleral icterus and generalized jaundice. His vital signs reveal a temperature of 37.2°C and a heart rate of 168 beats/min. You consider the diagnosis of neonatal hyperbilirubinemia, but how do you differentiate nonpathologic from pathologic causes of hyperbilirubinemia? Based on the visual diagnosis of jaundice, should you start treatment immediately with phototherapy? What additional laboratory testing is needed to determine the need for treatment and the disposition for this neonate? 

Make your best guess, and check back next month to find out the correct answer!

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