Differential Diagnosis for a 5-day-old with TCB 3.4
Single most likely diagnosis
- Physiological jaundice: This is the most common cause of jaundice in newborns, especially in the first week of life. The bilirubin level of 3.4 mg/dL at 5 days of age is within the range for physiological jaundice, which typically peaks between 3-5 days of age.
Other Likely diagnoses
- Breast milk jaundice: This condition occurs in breastfed infants due to substances in the breast milk that can increase bilirubin levels. It usually presents in the first or second week of life.
- Hemolytic disease of the newborn (HDN): Although less common, HDN due to blood group incompatibilities (like ABO or Rh) can cause elevated bilirubin levels. However, it typically presents earlier and with more severe symptoms.
Do Not Miss (ddxs that may not be likely, but would be deadly if missed)
- Biliary atresia: A congenital condition where the bile ducts are blocked, leading to severe jaundice. Early diagnosis and surgical intervention are crucial for survival.
- Infections (e.g., sepsis, urinary tract infections): Infections can cause or exacerbate jaundice in newborns and are medical emergencies.
- Congenital thyroidism: Hypothyroidism can cause prolonged jaundice, and early diagnosis is essential for preventing long-term developmental issues.
- Galactosemia: A genetic disorder that affects the body's ability to metabolize galactose, a sugar found in milk, leading to jaundice among other symptoms.
Rare diagnoses
- Crigler-Najjar syndrome: A rare genetic disorder affecting the enzyme responsible for bilirubin conjugation, leading to very high levels of unconjugated bilirubin.
- Gilbert syndrome: A mild genetic disorder that affects the liver's ability to process bilirubin, usually presenting later in life but can be a consideration in persistent jaundice.
- Other congenital liver diseases: Such as congenital hepatic fibrosis or neonatal hepatitis, which are rare but can cause jaundice in newborns.