NeonatalJaundice新生兒黃疸History.pptVIP

Neonatal Jaundice新生兒黃疸 History 病人是自然產出生一天大的男嬰；母親是24歲G2P1A1客家人，產前實驗室檢查正常，懷孕過程順利，group B streptococcus檢查是陰性，母親血型是 O positive，破水時間是 1 小時。男嬰出生體重是3270克，Apgar scores分別是8與9分，懷孕週數是40 週。男嬰出生第一天的餵食良好，體重只下降10克。他已有解尿及排便，家族史無特別發現。 男嬰在出生滿24小時呈現黃疸症狀，測腳底微血管的bilirubin值為17 mg/dl，轉至病嬰室接受進一步檢查與治療 History Physical Exam General appearance: Jaundiced infant in no distress Skin: Jaundiced HEENT: Icteric sclera Neck: Supple without masses Lungs: Clear without increased work of breathing Heart: Regular heart beat, no murmur Abdomen: Soft, nontender, no masses or organomegaly Hips: Normal Pulses: Normal What is your differential diagnosis? Physiologic jaundice Breast milk jaundice Hemolytic disease of the newborn Congenital viral infection Breastfeeding jaundice Glucose-6-phosphate dehydrogenase (G6PD) deficiency Re-Evaluation of Differential Diagnosis Physiologic jaundice Explanation: Jaundice that appears at birth or within the first 24 hours of life is always pathologic. Physiologic jaundice can be diagnosed by ruling out disorders by history, clinical findings, or laboratory results. Because this infants bilirubin was elevated prior to 24 hours of life, it is not physiologic. Breast milk jaundice Explanation: Breast milk jaundice develops in breastfed infants at approximately the first week of life. It gradually decreases over 3-10 weeks. It is an indirect hyperbilirubinemia. Jaundice developed too early in this newborn. Re-Evaluation of Differential Diagnosis Hemolytic disease of the newborn Explanation: Whenever the indirect bilirubin increases quickly, especially in the first 24 hours of life, hemolytic disease of the newborn must be considered. The mothers blood type is O positive, which would put the infant at risk with a blood type of A or B. Re-Evaluation of Differential Diagnosis Congenital viral infection Explanation: Congenital viral infections usually are associated with an increase in direct or conjugated bilirubin. These infections may be associated with