TYK385
A 3.8 kg one week-old full-term newborn boy arrives in the preoperative clinic in preparation for an eye exam under general anesthesia the next day. His family history is notable for being of southern Italian descent. During your examination, you note that he has jaundice to his umbilicus and scleral icterus. His exam is otherwise normal, including no hepatomegaly, aside from a soft cephalohematoma on the posterior scalp. Which of the following is the BEST response:
a) You are not concerned about the jaundice because the mother is breast-feeding
b) You opt for additional testing because of the family’s southern Italian heritage and the cephalohematoma
c) The boy’s mother explains that he is making at least one wet diaper a day, reassuring you that he is well-hydrated
d) No testing is necessary because the cephalohematoma is likely the cause of the jaundice
e) This infant should be admitted for phototherapy, based on your examination
Answer
Answer b. It is important to screen for G6PD in any infant of Mediterranean heritage. In addition, while cephalohematoma may increase the bilirubin value due to blood breakdown, this etiology does not decrease the risk to the infant of severe hyperbilirubinemia. CBC and total bilirubin as well as a G6PD screen should be performed.
Notes
- This question originally printed in the Pediatric Anesthesiology Review Topics kindle book series, and appears courtesy of Naerthwyn Press, LLC.