07-10-2009, 09:36 AM
You are the doctor on call in the well baby nursery at the community hospital. One of the nurses calls you to ask about one of your patients. The baby is now 30 hours old and was born full term via vaginal delivery to a healthy 28-year-old mother. There were no complications at the delivery and the baby has been feeding well. The nurse is concerned that the baby looks "yellow". You ask her to send for a bilirubin level. A few hours later she calls to tell you that the total bilirubin level has come back at 18 mg/dL with a direct bilirubin level of 0.6 mg/dL. The parents are now concerned about the baby's discoloration. The most appropriate next step is to
A. reassure the mother that this is completely normal and no additional studies or treatment are indicated
B. repeat the bilirubin level immediately as the result must be a lab error
C. start phototherapy and repeat the bilirubin level in 6 hours
D. transfer to the nearest neonatal intensive care unit for an exchange transfusion
E. wait 6 hours and repeat the bilirubin level
A. reassure the mother that this is completely normal and no additional studies or treatment are indicated
B. repeat the bilirubin level immediately as the result must be a lab error
C. start phototherapy and repeat the bilirubin level in 6 hours
D. transfer to the nearest neonatal intensive care unit for an exchange transfusion
E. wait 6 hours and repeat the bilirubin level