By Bradley S. Marino MD MPP MSCE, Katie S. Fine MD
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It disappears in the opposite direction; scleral icterus is generally the last to resolve. • Family history of hemolytic anemia, liver disease, or sibling with nonphysiologic jaundice as a neonate DIAGNOSTIC EVALUATION • Jaundice in an SGA infant pathology (biliary atresia, neonatal hepatitis) and congenital infections; two additional causes to consider are α-antitypsin deficiency and galactosemia (Chapter 18). ABO incompatibility is the most common cause of pathologic unconjugated hyperbilirubinemia.
22 • Blueprints Pediatrics be performed in all newborns and at all early infancy health maintenance visits. The feet should be examined for metatarsus adductus (medial curving of the forefoot), talipes equinovarus (“clubfoot”), and other anomalies. The diagnoses and treatments of these conditions are discussed in Chapter 16. BACK Palpate the entire length of the bony spine. Look for dimples, hair tufts, or hemangiomas overlying the spine. They may be associated with underlying neurologic anomalies (see Chapter 15).
TABLE 2-9 Newborn Early Discharge Criteria Discharge prior to 48 hr of age may be considered appropriate if: • the infant is full-term • the infant has a normal physical examination • the infant has maintained normal vital signs • the infant is urinating and stooling • the infant has had at least two consecutive successful feedings (breast or bottle) • a risk assessment for hyperbilirubinemia has been completed and appropriate follow-up ensured (must be within 2 d of discharge) • the circumcision site is healing without bleeding (if applicable) • the risk for Group B streptococcal disease has been assessed and addressed • maternal prenatal labs are negative/reassuring • the parents have been educated regarding infant feeding expectations, the benefits of breastfeeding, skin/cord/ circumcision care, car seat use, “Back to Sleep,” prevention of shaken baby syndrome, etc.
Blueprints Pediatrics by Bradley S. Marino MD MPP MSCE, Katie S. Fine MD