1. 1 Clerk Meeting Case presentation 範例 簡單扼要的討論 Slides 不要太多

2. 2 Case Presentation Topic: Jaundice XXX

3. 3 History Baby of CH Lin Age: 5 day Sex: Male Admitted at 16/09/03 Informant: mother

4. 4 Chief complaint yellow discoloration of skin for 1 day Onset at Day 4 after birth

5. 5 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

6. 6 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

7. 7 Social History Father: aged 35, businessman Mother: aged 30, housewife Both parents enjoy good past health Single child and is cared by mother

8. 8 Working diagnosis base on history Physiological jaundice Breast feed jaundice Hemolysis –G6PD deficiency –Blood group incompatibility

9. 9 Physical Examination General condition: BW: 3.5 kg afebrile alert & active Jaundice Not dehydrated Normal skin turgor Capillary refill < 1 second Anterior fontanelle is soft

10. 10 Physical Examination no pallor no central cyanosis heart sound : Heart rate:140 beats per minute Dual, added sound, no murmur

11. 11 Physical Examination abdomen soft, non-tender, no distension No hepatosplenomegaly chest : Respiratory: 40 per minutes clear

12. 12 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

13. 13 Management The most likely diagnosis is Physiological jaundice Reassurance Monitor serum bilirubin Phototherapy

14. 14 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

15. 15 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

16. 16 Criteria that rule out physiological jaundice –Jaundice within the first 24 hours –Jaundice persist >1 week in term or >2 week in preterm infants –Rapid rise of bilirubin –Very high Bilirubin level –High Conjugated bilirubin level

17. 17 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

18. 18 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