Differential Diagnosis for Neonatal Jaundice

The following differential diagnosis is based on the information provided about a 22-year-old primigravida and her newborn presenting with jaundice.

• Single Most Likely Diagnosis

  • Sulfonamide-induced jaundice (e.g., Trimethoprim-sulfamethoxazole): This is likely because sulfonamides, such as those found in trimethoprim-sulfamethoxazole, are known to displace bilirubin from albumin, increasing the risk of jaundice in newborns. The mother's recent medication use before labor, which she cannot recall, makes this a plausible option given the context.

• Other Likely Diagnoses

  • Tetracycline-induced jaundice: Tetracyclines can also cause liver dysfunction and are contraindicated in pregnancy due to the risk of inhibiting bone growth and causing tooth discoloration in the fetus. However, they are less commonly associated with neonatal jaundice compared to sulfonamides.
  • Ciprofloxacin: Although ciprofloxacin is a fluoroquinolone antibiotic and its use in pregnancy is generally avoided due to potential effects on cartilage development, it is not as commonly associated with neonatal jaundice as sulfonamides.

• Do Not Miss Diagnoses

  • Hemolytic disease of the newborn (HDN): This condition, often due to Rh or ABO incompatibility between the mother and the fetus, can lead to severe jaundice. Although less likely given the context of recent medication use, it is critical to rule out due to its potential severity and need for prompt treatment.
  • Biliary atresia or other congenital liver anomalies: These conditions can cause jaundice and are crucial to diagnose early for appropriate management, including potential surgical intervention.

• Rare Diagnoses

  • Other drug-induced jaundice: While many drugs can potentially cause jaundice, the likelihood varies widely, and most are less common causes compared to sulfonamides in this context.
  • Infectious causes of jaundice: Certain infections can cause jaundice in newborns, but these would typically be accompanied by other symptoms such as fever, lethargy, or feeding difficulties, which are not mentioned in the scenario provided.