A term neonate, with a bih weight of 2700 g, who is otherwise well, and is exclusively breastfed, presents for routine evaluation. His total serum bilirubin is found to be 14mg/dl on day 5. What is the management?
Management of above case is by giving Routine baby care to baby, no active treatment is required. Breastfeeding need not to be stopped unless Contra-indicated AAP provides two age-specific nomograms for neonates >=35 weeks gestation- one each for phototherapy and exchange transfusion. The nomograms have lines for three different risk categories of neonates- lower risk babies (38 wk or more and no risk factors), medium risk babies (38 wk or more with risk factors, or 35 wk to 37 wk without any risk factors) and higher risk (35 wk to 37 wk and with risk factors) As a rough guide, phototherapy is initiated if TSB vales are >10 mg/dl at 24 hours >=13 mg/dL at 48 hours >=15 mg/dL at 72 hours >= 18 mg/dL at 96 hours and beyond in babies at medium risk. The babies at lower and higher risk have their cut-offs at approximately 2 mg/dL higher or 2 mg/dL lower than that for medium risk babies, respectively. Risk factors include: Presence of isoimmune hemolytic anemia G6PD deficiency Asphyxia Temperature instability Hypothermia Sepsis Significant lethargy Acidosis Hypoalbuminemia
Phototherapy
Exchange transfusion
Stop breastfeeding for 2 days
No active treatment required
NEET Jan 2020