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Clerk Meeting

Case presentation 範例

簡單扼要的討論Slides 不要太多

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Case PresentationTopic: Jaundice

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History

• Baby of CH Lin

• Age: 5 day

• Sex: Male

• Admitted at 16/09/03

• Informant: mother

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Chief complaint

• yellow discoloration of skin for 1 day

• Onset at Day 4 after birth

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History of Presenting Illness

• breast feeding every 3 hours • Feeding well tolerated • Good sucking effort• Urine output : 6-7 wet napkin/day • no tea color urine • no pale stool • no vomiting • no diarrhea • afebrile

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Birth History

• Born in NCKUH

• G1P1, NSD, Full term

• Vacuum extraction due to suspected fetal distress, AS: 9 10

• Birth weight:3.58kg

• Immunization was up to date

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Social History

• Father: aged 35, businessman

• Mother: aged 30, housewife

• Both parents enjoy good past health

• Single child and is cared by mother

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Working diagnosis base on history

• Physiological jaundice

• Breast feed jaundice

• Hemolysis – G6PD deficiency – Blood group incompatibility

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Physical Examination

• General condition: BW: 3.5 kgafebrile

alert & active

Jaundice

Not dehydrated

Normal skin turgor Capillary refill < 1 second Anterior fontanelle is soft

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Physical Examination

• no pallor

• no central cyanosis

• heart sound : Heart rate:140 beats per minute

Dual, added sound,

no murmur

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Physical Examination

• abdomen

soft, non-tender, no distension

No hepatosplenomegaly

• chest : Respiratory: 40 per minutes

clear

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Investigation

• Serum bilirubin: 16.5 on 16/9

• Blood Test

Mother : A positive

Baby: O postive

Direct Coombs’ Test : negative

• G6PD & TSH screening result: normal

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Management

• The most likely diagnosis is Physiological jaundice

• Reassurance

• Monitor serum bilirubin

• Phototherapy

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Progress

• Serum bilirubin level decreased to 10.2 after 2-day phototherapy

• Patient was discharged on 18/9

• Follow-up in Neonatal clinic 1 month later

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Discussion

• Physiological Jaundice

• Transition from fetal to adult bilirubin metabolism

• Start from D2 to D4

• Reach maximum at D4 to D6

• Back to normal from D5 to D7 (up to 2 week in preterm infants)

• Clinically well except jaundice

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Criteria that rule out physiological jaundice

– Jaundice within the first 24 hours – Jaundice persist >1 week in term or >2 wee

k in preterm infants – Rapid rise of bilirubin – Very high Bilirubin level – High Conjugated bilirubin level

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Management

• Reassurance to parents Most physiological jaundice will be returned to

normal after few days

Regular monitoring of serum bilirubin

• Phototherapy

Blue light (450nm) that convert bilirubin to lumirubin

Bypass the liver conjugating system

• Exchange Transfusion Indicated only when serum bilirubin very high

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Side effects of Phototherapy

• increased body temp & fluid lost due to radiant heat

• retinal damage : eye shield

• photo rash : UV light induced mast cell damage