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Old 06-15-2011
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Kids Baby with jaundice, poor feeding, and vomiting

A 7-day-old female neonate is brought to your office for a 2-day history of jaundice and poor feeding. The mother also says that she has vomited twice but she doesn't appear febrile. She is breast-feeding her baby regularly. The baby's birth history is unremarkable. On examination the child appears listless, and mild jaundice along with signs of dehydration are noted. Her vitals are: BP: 78/52mm of Hg; PR: 150/min; Temperature: 36C(96F). Family history is insignificant. What is the most appropriate next step in the management of this patient?

A. Stop breast feeding
B. Obtain blood cultures and lumbar puncture
C. Obtain peripheral smear and reticulocyte count
D. Obtain liver function tests
E. Obtain Coomb's test and osmotic fragility test
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Old 06-15-2011
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B. Need to rule out occult neonatal sepsis.
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Old 06-16-2011
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this looks more like breast milk jaundice! so stop the feeding, give formula and continue after 2 days!
For neonatal sepsis the fever is missing (36degrees)
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Quote:
Originally Posted by cool_atomic View Post
this looks more like breast milk jaundice! so stop the feeding, give formula and continue after 2 days!
For neonatal sepsis the fever is missing (36degrees)
Fever is not always present in 7 days old. Usually features of neonatal sepsis are non-specific. Need to have low threshold!
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Old 06-16-2011
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Quote:
Originally Posted by cool_atomic View Post
this looks more like breast milk jaundice! so stop the feeding, give formula and continue after 2 days!
For neonatal sepsis the fever is missing (36degrees)
breast milk jaundice is in 2 week

and the answer is B as workup for neonatal sepsis (poor feeding and jaundice )
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