Child (Breast fed) at 30 hrs. of life develops yellowing of face, palm and soles not true is :
Correct Answer: Physiological jaundice
Description: Ans. is 'c' physiological jaundice Child presents with severe jaundice at 30 hrs. of life (or we can say 2nd day of life.) Yellowing of face, palms and soles indicate that bilirubin level is > 15 mg/dl (For explanation see O.P. Ghai 5th/e, P 143) Now we will have to look for conditions which can cause such an elevation in bilirubin level by 2nd days. Both septicemia and congenital obliteration of bile duct can present with severe jaundice on the 2nd day of life. The other 2 options Breast milk jaundice & physiological jaundice cannot cause such an elevation in bilirubin by 2nd day of life. Now let's see them one by one. Breast milk jaundice In breast milk jaundice significant elevation in bilirubin occurs by 7th day of life reaching maximum concentration of 10-30 mg/dl by 2nd-3rd week. Physiological jaundice For jaundice to be physiologic rather than pathologic following 4 criteria's should be satisfied (C.P.D.T. 15*/e, page 13). Clinical jaundice appears after 24 hrs. of age.* Total bilirubin rises by less than 5 mg/dl per day.* Now we can easily exclude this, if the jaundice appears on 2nd day and per day rise in bilirubin is 5 mg/dl, how can it reach 15 mg in the same day. Other two criteria's for physiological jaundice. Peak bilirubin occurs at 3-5 days of age*, with a total bilirubin of no more than 15 mg/dl.* Clinical jaundice is resolved by 1 week in the term infant and by 2 weeks in the preterm infant.
Category:
Pediatrics
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