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  #1  
Old 07-05-2011
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Kids 4 day old female child with jaundice

A 4 day old female child with yellow skin and eyes . The baby was born at term by a normal vaginal delivery. Pregnancy was uncomplicated; there were no risk factors for sepsis and no history of maternal alcohol or drug use. The baby is breast fed and has been nursing every 2 hours, about 10 minutes at each breast. The bilirubin level is 15 mg (unconjugated) , the hematocrit is 45% and the combs test is negative. Which of the following is the most likely diagnosis?

A. Congenital biliary atresia
B. Isoimmune hemolytic disease
C. Crigler-Najjar syndrome
D. Breast milk jaundice
E. Breast feeding jaundice
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  #2  
Old 07-05-2011
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D. Breast milk juandice (BMJ), It should be differentiated from breastfeeding jaundice, which manifests in the first week of life and is caused by insufficient production or intake of breast milk.
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  #3  
Old 07-05-2011
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Quote:
Originally Posted by aksyonez View Post
A 4 day old female child with yellow skin and eyes . The baby was born at term by a normal vaginal delivery. Pregnancy was uncomplicated; there were no risk factors for sepsis and no history of maternal alcohol or drug use. The baby is breast fed and has been nursing every 2 hours, about 10 minutes at each breast. The bilirubin level is 15 mg (unconjugated) , the hematocrit is 45% and the combs test is negative. Which of the following is the most likely diagnosis?

A. Congenital biliary atresia
B. Isoimmune hemolytic disease
C. Crigler-Najjar syndrome
D. Breast milk jaundice
E. Breast feeding jaundice

the answer is C Crigler -Najjar syndrome
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  #4  
Old 07-05-2011
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i think it`s brest milk jundice
biliary atresia (conjugated hyperbilirubinaemia )
najar syndrome appear from 1st day
isoimmune haemolytic anaemia bilirubin will be more than 15 gm/dl
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Old 07-05-2011
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breast milk jaundice should start after 1 week. i go with crigler-najjar
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  #6  
Old 07-06-2011
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Here is the uptodate comments

Breast milk jaundice is defined as the persistence of physiologic jaundice beyond the first week of age. It typically begins after the first three to five days of life, peaks within two weeks after birth, and progressively declines to normal levels over 3 to 12 weeks .B
reast milk jaundice (unconjugated hyperbilirubinemia in breast-fed newborns) is similar to neonatal jaundice except that serum bilirubin levels are higher (up to 30 mg/dL if untreated) and persist for a longer duration. They usually peak within two weeks of birth, remain elevated for 4 to 10 days, and then decline to normal over 3 to 12 weeks.

The hallmark of Crigler-Najjar syndrome type I is pure unconjugated hyperbilirubinemia, which is usually in the range of 20 to 25 mg/dL but can be as high as 50 mg/dL Stool color is normal, but fecal urobilinogen excretion is diminished due to the marked reduction in the conjugation of bilirubin. Criggler Najjar type II is associated with lower bilirubin levels (<20).
Based on these this patient if has breast milk jaundice should experience the high serum levels at the second week. So the diagnosis of CN in better, although based on these explanations i cannot completely rule out breast milk jaundice.





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Old 07-06-2011
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i m with C. Crigler-Najjar syndrome
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  #8  
Old 07-06-2011
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pls give the correct answer n y the other options are not correct.thnks
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Old 07-06-2011
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E. Breast feeding jaundice wrong child is not dehydrated
D. Breast milk jaundice in 2nd weeks of age wrong answer

B. Isoimmune hemolytic disease wrong because must be positive coombs test

A. Congenital biliary atresia wrong no sunken abdomen no respiratory distress


so the answer is

C. Crigler-Najjar syndrome
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  #10  
Old 07-06-2011
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Ok here it is:

Congenital biliary atresia : infants usually have icterus by 2-6 weeks of age and have high CONJUGATED BILIRUBIN, dark urine and acholic stools so A is not the answer.
B. Isoimmune hemolitic disease is not the answer because indirect coombs test will be positive in mother and Coombs test weakly positive is infant and ANEMIA is usually present
C. Crigler-Najjar syndrome is autosomal recessive with marked UnConjugated Hyperbilirubin (20-40 mg) in otherwise asymptomatic child so C is not the answer.
D. Breast milk jaundice is not the answer because it presents in SECOND WEEK OF LIFE and this child is 4 days old.It can increse by the 7 th day of life at the earliest and concentrations are up to 30 mg/dl

E. is the answer Breast Feeding Jaundice because it appears in 2-4 days of life . Just because the infant is fed every 2 hours does not mean the baby is successfully getting enough milk.
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  #11  
Old 07-06-2011
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Quote:
Originally Posted by aksyonez View Post
Ok here it is:

Congenital biliary atresia : infants usually have icterus by 2-6 weeks of age and have high CONJUGATED BILIRUBIN, dark urine and acholic stools so A is not the answer.
B. Isoimmune hemolitic disease is not the answer because indirect coombs test will be positive in mother and Coombs test weakly positive is infant and ANEMIA is usually present
C. Crigler-Najjar syndrome is autosomal recessive with marked UnConjugated Hyperbilirubin (20-40 mg) in otherwise asymptomatic child so C is not the answer.
D. Breast milk jaundice is not the answer because it presents in SECOND WEEK OF LIFE and this child is 4 days old.It can increse by the 7 th day of life at the earliest and concentrations are up to 30 mg/dl

E. is the answer Breast Feeding Jaundice because it appears in 2-4 days of life . Just because the infant is fed every 2 hours does not mean the baby is successfully getting enough milk.
Crigler-Najjar syndrome 2 indirect is less than 20

u right the answer could be 2 i remember idid q similar

from where this q ??????
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