What history should be taken from a 9-day-old baby with jaundice?

History Taking for a 9-Day-Old Baby with Jaundice

When evaluating a 9-day-old baby with jaundice, a thorough history should focus on identifying risk factors for severe hyperbilirubinemia, determining the timing of jaundice onset, and assessing for any signs of pathologic causes. 1

Essential History Elements

Timing and Progression of Jaundice

• When the jaundice first appeared (jaundice in first 24 hours is considered pathologic until proven otherwise) 1, 2
• Pattern of progression (rapid rise is concerning)
• Any changes in intensity or distribution

Feeding History

• Breastfeeding vs. formula feeding (exclusive breastfeeding is a risk factor) 1
• Frequency of feeds (8-12 times daily recommended) 1
• Adequacy of intake:
  • Number of wet diapers per day
  • Number and character of stools (pale stools may indicate cholestasis) 1, 2
  • Weight loss since birth (percentage from birth weight)

Birth History

• Gestational age (35-36 weeks is a major risk factor) 1, 2
• Birth weight
• Mode of delivery
• Presence of birth trauma, cephalohematoma, or significant bruising 1
• Timing of hospital discharge (early discharge increases risk) 1

Family History

• Previous siblings with jaundice or who received phototherapy (major risk factor) 1
• Family ethnicity (East Asian race is a risk factor; G6PD deficiency more common in certain ethnic groups) 1, 2
• Known blood disorders or liver diseases in family

Medical History

• Blood type of mother and baby (if known)
• Results of any previous bilirubin measurements
• Any known hemolytic disease
• Any signs of illness or infection
• Medications given to baby

Red Flags to Identify

• Jaundice appearing within first 24 hours of life 1, 2
• Rapidly rising bilirubin levels (crossing percentiles on nomogram) 1
• Poor feeding, lethargy, or irritability
• Dark urine or pale/clay-colored stools (suggests cholestasis) 1, 2
• Jaundice persisting beyond 2 weeks (requires direct bilirubin measurement) 1, 2
• Fever or other signs of infection

Assessment of Risk Factors

Systematically assess for risk factors for severe hyperbilirubinemia:

Major Risk Factors

• Previous TSB or TcB level in high-risk zone
• Jaundice in first 24 hours
• Blood group incompatibility with positive direct Coombs test
• Gestational age 35-36 weeks
• Previous sibling received phototherapy
• Cephalohematoma or significant bruising
• Exclusive breastfeeding with poor nursing or excessive weight loss
• East Asian race 1

Minor Risk Factors

• Gestational age 37-38 weeks
• Jaundice observed before discharge
• Previous sibling with jaundice
• Macrosomic infant of diabetic mother
• Maternal age ≥25 years
• Male gender 1

Special Considerations

• For jaundice persisting beyond 2 weeks, ask specifically about urine and stool color to rule out cholestasis 1, 2
• For late-rising bilirubin, consider G6PD deficiency, especially in certain ethnic backgrounds 2
• If the infant appears sick or has other symptoms, expand history to include fever, poor feeding, lethargy, or vomiting 1

Common Pitfalls to Avoid

• Failing to ask about jaundice in previous siblings (important risk factor) 2
• Treating 35-37 week gestation infants as if they were full-term (they have higher risk) 2
• Ignoring jaundice in the first 24 hours (always pathologic until proven otherwise) 1, 2
• Not asking about stool color in prolonged jaundice (may miss biliary atresia) 2
• Overlooking feeding difficulties that may contribute to jaundice 1

Following this systematic approach to history-taking will help identify infants at risk for severe hyperbilirubinemia and those who may have pathologic causes requiring further evaluation and treatment.