What is the most likely cause of jaundice in a 5-day-old boy with a total serum bilirubin concentration of 20 mg/dL, primarily indirect hyperbilirubinemia, and negative direct and indirect antiglobulin (Coombs) tests?

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Differential Diagnosis for Neonatal Jaundice

Single Most Likely Diagnosis

  • D) Physiologic jaundice: This is the most common cause of neonatal jaundice, especially in a healthy, term infant with no other signs of illness. The onset of jaundice after 24 hours of life, the presence of yellow, seedy stools, and the absence of other clinical abnormalities support this diagnosis.

Other Likely Diagnoses

  • B) Enzyme deficiency: Although less common, enzyme deficiencies such as glucose-6-phosphate dehydrogenase (G6PD) deficiency, which is more prevalent in individuals of Mediterranean descent, can cause neonatal jaundice. The mother's use of sulfamethoxazole, a known trigger for hemolysis in G6PD-deficient individuals, increases the likelihood of this diagnosis.
  • C) Milk protein allergy: Though not as common as physiologic jaundice, a milk protein allergy could potentially cause jaundice in a neonate, especially if the infant is formula-fed, as in this case.

Do Not Miss Diagnoses

  • E) Sepsis: Although the infant shows no other signs of illness, sepsis can present subtly in neonates and is a life-threatening condition that requires prompt diagnosis and treatment. Jaundice can be an early sign of neonatal sepsis.
  • A) Dehydration: Dehydration can exacerbate jaundice and is important to recognize and treat promptly to prevent complications.

Rare Diagnoses

  • Other enzyme deficiencies or congenital disorders: While less likely, other rare enzyme deficiencies or congenital disorders could potentially cause jaundice in a neonate. However, these would be less likely given the information provided and the absence of other clinical abnormalities.

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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