History Taking in Jaundice

History of Present Illness • • • • • • • • •

Onset and progression of jaundiced skin Feeding: breast milk or formula? Current Current weight compared to birth weight. Gaining weight appropriately? Number of wet diapers per day? !ndicator of hydration status" Consistency and colour of stool?pale stool implies poor bili e#cretion" !nfections or fe$er? %edications? newborn or mother" General acti$ity: irritable? lethargic? Gender & ethnicity? %ales' (sians' and )lacks ha$e some increased risk

Perinatal History • • • • • • •

%aternal blood group %aternal illnesses or infections *esults *esults of antenatal screening tests %aternal medicine or drug intake +elayed cord clamping could indicate polycythemia" )irth trauma with bruising *esults of newborn screening tests

Family History: • • • • •

,re$ious ,re$ious siblings with neonatal jaundice Other family members with jaundice (nemia or blood disorders -plenectomy )ile stones or gallbladder remo$al

Merck Manual Histo History ry of presen presentt illnes illness s sh shou ould ld note note age age of onse onsett and and dura durati tion on of jaun jaundi dice ce.. !mportant associated symptoms include lethargy and poor feeding suggesting possible kernicterus"' which may progress to stupor' hypotonia' or seiures and e$entually to hypertonia. ,atterns of feeding can be suggesti$e of possible breastfeeding failure or underfeeding. /herefore' history should include what the infant is being fed' how much and and how how fre0 fre0ue uent ntly ly'' urin urine e and and stool stool prod produc ucti tion on pos possi sibl ble e brea breast stfe feed edin ing g failu failurre or underfeeding"' how well the infant is latching on to the breast or taking the nipple of the bottle' whether the mother feels that her milk has come in' and whether the infant is swallowing during feedings and seems satiated after feedings. Review of systems  should seek symptoms of causes' including respiratory distress' fe$er' and irritability or lethargy sepsis"1 hypotonia and poor feeding hypothyroidism' metabolic disorder"1 and repeated episodes of $omiting intestinal obstruction". Past medica medicall histor history y should should focus focus on mater maternal nal infect infection ions s to#o to#opla plasmo smosis sis'' other other pathogens' rubella' cytomegalo$irus' and herpes simple# 2/O*C34 infections"' disorders that can cause early hyperbilirubinemia maternal diabetes"' maternal *h factor and blood group maternofetal blood group incompatibility"' and a history of a prolonged or di5cult birth hematoma or forceps trauma".

Family history should note known inherited disorders that can cause jaundice' including G6,+ de7ciency' thalassemias' and spherocytosis' and also any history of siblings who ha$e had jaundice. Drug history should speci7cally note drugs that may promote jaundice eg' ceftria#one' sulfonamides' antimalarials". Medscape Presentation and duration of neonatal jaundice • •

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 /ypically' presentation is on the second or third day of life.  8aundice that is $isible during the 7rst 9 hours of life is likely to be nonphysiologic1 further e$aluation is suggested. !nfants who present with jaundice after ;< days of life may also re0uire closer scrutiny and monitoring. !n infants with se$ere jaundice or jaundice that continues beyond the 7rst =<9 weeks of life' the results of the newborn metabolic screen should be checked for galactosemia and congenital hypothyroidism' further family history should be e#plored see below"' the infant>s weight cur$e should be e$aluated' the mother>s impressions as far as ade0uacy of breastfeeding should be elicited' and the stool color should be assessed.

Family history •

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,re$ious sibling with jaundice in the neonatal period' particularly if the jaundice re0uired treatment Other family members with jaundice or known family history of Gilbert syndrome (nemia' splenectomy' or bile stones in family members or known heredity for hemolytic disorders i$er disease in family members

History of pregnancy and delivery • • • •

%aternal illness suggesti$e of $iral or other infection %aternal drug intake +elayed cord clamping )irth trauma with bruising and@or fractures.

Postnatal history • • • • • •

oss of stool color )reastfeeding Greater than a$erage weight loss -ymptoms or signs of hypothyroidism -ymptoms or signs of metabolic disease eg' galactosemia" A#posure to total parental nutrition