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Changes during the transition between intrauterine to extrauterine life?

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Changes during the transition between intrauterine to extrauterine life?

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1. Make sure airways are free (and breathing is happening)

2. Make sure to dry neonate (fricition creates heat and stimulates baby to breathe) 3. Measure APGAR at 1 and 5 minutes during transition (appearance, pulse, grimace, activity, respiration) (on top of mom)

4. Delayed cord clamping (30s-3min)

5. Sometimes incubator

6. Check suction

7. Make sure neonate is fed

8. Careful about glucose levels

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What is the normal physiology of the newborn?

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What is the normal physiology of the newborn?

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Neonatal issues below, what more do you test if you suspect those conditions?

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Neonatal issues below, what more do you test if you suspect those conditions?

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What are APGAR scores and how do you apply them?

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What are APGAR scores and how do you apply them?

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What further exams can we do? What more can we test in a normal baby?

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What further exams can we do? What more can we test in a normal baby?

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A neonate, born at 40 weeks of gestation, develops yellow discoloration of the skin on the third day after birth. The parents notice this discoloration on the face and trunk. On physical examination, the infant is alert, reactive, and breastfeeding well.

Problem Description

A term neonate develops jaundice on the third day of life, most prominent in the face and trunk. The neonate is alert, reactive, and feeding well, suggesting that the infant is currently clinically stable. However, the jaundice indicates hyperbilirubinemia.

Differential Diagnosis

Physiological jaundice: The most common type of neonatal jaundice, typically peaking on the third to fourth day of life and subsequently declining. It is usually benign.

Subclinical underfeeding: Jaundice may occur due to inadequate breastfeeding, resulting in reduced bilirubin excretion via stool and increased enterohepatic circulation.

Breast milk jaundice: Occurs a few days after birth due to the composition of breast milk, which reduces bilirubin elimination.

Hemolytic jaundice: Caused by blood group incompatibility (e.g., ABO or Rh), leading to increased red blood cell breakdown and elevated bilirubin levels.

Infection: Neonatal infections can cause hyperbilirubinemia, although there are no additional signs of infection in this case.

Congenital hypothyroidism: May present with prolonged jaundice, but typically accompanied by lethargy and poor feeding, which are not observed here.

Concerning vs. Non-concerning Presentation

Non-concerning (“pluis”), but requires careful monitoring. The infant is alert, reactive, and feeding well, which is reassuring.

However, clinical observation of jaundice does not correlate reliably with serum bilirubin levels. Severe hyperbilirubinemia (e.g., due to hemolysis or infection) must therefore be excluded.

Diagnostic Options

Serum bilirubin: Measurement of total and direct bilirubin is essential to assess severity and to distinguish between conjugated and unconjugated hyperbilirubinemia.

Blood group and Coombs test (DAT): To evaluate for ABO or Rh incompatibility as a cause of hemolysis.

Complete blood count: To assess for anemia or signs of hemolysis.

Glucose-6-phosphate dehydrogenase (G6PD) testing: Considered in cases of severe hyperbilirubinemia, especially in at-risk ethnic groups.

Infection workup: If clinical signs of infection (e.g., fever, lethargy) or risk factors are present, perform CRP, blood culture, or urine culture.

TSH and T4: To exclude congenital hypothyroidism.

Management Options Based on Differential Diagnosis

Physiological jaundice:

Usually requires no intervention, only monitoring of bilirubin levels.

If bilirubin rises to risk thresholds (based on age in hours and serum levels), phototherapy may be indicated.

Subclinical underfeeding:

Encourage the mother to start pumping and consider supplementation with formula to ensure adequate intake.

Monitor bilirubin levels; initiate phototherapy if levels become elevated.

Breast milk jaundice:

Typically resolves spontaneously; breastfeeding should not be discontinued.

Hemolytic jaundice:

In cases of blood group incompatibility (positive Coombs test), phototherapy may be required.

In severe hyperbilirubinemia, exchange transfusion may be necessary.

Intravenous immunoglobulin (IVIG) can be administered to reduce red blood cell destruction.

Infection:

If confirmed, initiate antibiotic therapy.

In sepsis, the blood–brain barrier becomes more permeable, increasing the risk of kernicterus in the setting of severe hyperbilirubinemia.

Congenital hypothyroidism:

If diagnosed, initiate treatment with thyroid hormone replacement (levothyroxine).

Rare cause of neonatal jaundice, but important to exclude.