MedBugs: SAQ #94

Case: Neonatal jaundice

A 5 day old male who was discharged 48 hours ago from the post-natal ward has been brought in by his mother for poor feeding and lethargy. He is exclusively breastfed. In the last 24hrs, he has been falling asleep at the breast before completing a feed and needs to be woken up for feeds every 3 hours. Mum is also worried that her milk supply has not yet established and is still low. Baby was born at term without significant antenatal concerns and no admission to special care nursery. His vital signs are as follows: HR 145, RR 35, sats 96% on RA, cap refill 2 seconds, temp 37.0, BSL 4.1 Birth weight: 3400g Current weight: 3200g

1. Outline (5) causes of poor feeding in ANY neonate 5 marks

2. At what weight threshold would weight loss in a neonate be a clinical concern? 1 mark

On examination you notice moderate scleral icterus and yellowing of the skin to the head and torso

3. List, with justification, (4) investigations you would consider as part of the work-up for neonatal jaundice 4 marks

The serum bilirubin returns at 200umol/L, which is marginally under the phototherapy threshold on the bilirubin nomogram chart. The other investigations are also reassuring for a benign cause of jaundice, namely mild dehydration.

4. How would you safety-net this baby and his mother on discharge? 2 marks

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Case: Neonatal jaundice

1. Outline (5) causes of poor feeding in ANY neonate 5 marks

2. At what weight threshold would weight loss in a neonate be a clinical concern? 1 mark

3. List, with justification, (4) investigations you would consider as part of the work-up for neonatal jaundice 4 marks

4. How would you safety-net this baby and his mother on discharge? 2 marks

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