breastfeed jaundice

Question 1

task

Answer 1

Baby Helen is brought to see you in a general practice setting, as her mother is concerned about her continuing
jaundice. Helen is now two weeks old and was born at term by easy vaginal delivery weighing 3.7 kg. Apgar scores
were 9 and 10 (at 1 and 5 minutes respectively).
She became jaundiced in the neonatal period starting on day three. Investigations then revealed no blood group
incompatibility, both mother and baby being group O positive and no red blood cell (including enzymes) abnormality.
The infant was treated with phototherapy for two days. Since discharge from hospital at eight days of age the jaundice
has persisted and the mother is concerned. Baby is feeding well from the breast. Current weight is 3.9 kg.
Examination findings
The baby was active and clinically normal apart from the jaundice when you saw her yesterday. You arranged
investigations as set out below. The mother has now returned with the baby to discuss the results and your advice
about treatment.
Investigation results
* Serum bilirubin Total: 250 umol/L
~ Conjugated: less than 10 umol/L
* Neonatal thyroid screening normal
* Urine culture sterile
* Full Blood Examination (FBE) normal

Question 2

imp note

Answer 2

well baby with persisting jaundice, nomral urine color, bowel movements, and no other abnormalitis cliches diagnosis

Question 3

hx

Answer 3

-is this your first baby, bf well
-birth : normal , apgar
-good weight gain, feeding
-urine color> bowel normal
-colour of urine and motion

Question 4

explain

Answer 4

-explain investigations
-hx ex, and ix suggests the diagnosis is breaskmilk jaundice
-self limiting require no treatment
-dx confirmed by suspending(not stopping) breast milk for 24-48hrs>bilirubin drops,
then bf can continue. It is acceptable but not necessary
-if temporary suspension>advice to express breast milk to maintain lactation
-emphasis nothing wrong with her breast milk, phototherapy not required