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You are evaluating a term neonate for hyperbilirubinemia. The baby was sent home at 36 hours of life with a bilirubin measurement of 7.0, and has returned at 72 hours of life due increased jaundice.
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November 17, 2021 at 8:19 pm
A) Bilirubin level currently of 14.5
A rate of rise > 0.2 mg/dL per hour is concerning, and in this case, going from 7.0 to 14.5 over 36 hours is > 0.2. A bilirubin:albumin ratio > 7 is consistent with all of the albumin binding sites being occupied. The direct antibody test (DAT), or Coomb’s test, looks for maternal antibodies attached to the infant’s RBC. A positive DAT indicates likely blood type (e.g. ABO or Rh) incompatibility, leading to hemolysis and increased hyperbilirubinemia. Exclusive breastfeeding and East Asian race are risk factors for hyperbilirubinemia, as are preterm gestation, jaundice present in the first 24 hours of life, cephalohematoma or significant bruising, G6PD deficiency, and sibling that required phototherapy.