Physiologic jaundice is due to the breakdown of fetal red blood cells, and bilirubin rises at a rate of less than 5 mg/dL per 24 h, with a peak of 5 to 6 mg/dL during the second to the fourth day of life, returning to <2 mg/dL by 5 to 7 days. Septic infants with hyperbilirubinemia also have other features of sepsis, such as vomiting, abdominal distention, respiratory distress, and poor feeding. Jaundice associated with breast-feeding is thought to be due to the presence of substances that inhibit glucuronyl transferase in breast milk; it may start as early as the third to fourth day and reaches a peak of 10 to 27 mg/dL by the third week of life. Cessation of breast-feeding causes rapid decline in 2 to 3 days.
A proper history and physical examination provide clues to the causes of jaundice. A well-looking child who is gaining weight and feeding well is unlikely to be septic. Laboratory evaluation should include a full blood count to test for anemia, a smear for hemolysis, direct and total bilirubin determinations, a reticulocyte count, and a Coombs test. Admission to the hospital, appropriate cultures, and antibiotics are ordered for neonates who are unwell and have any of the signs or symptoms listed in Table., 112-5. In all cases, arrangements should be made for monitoring of bilirubin and hemoglobin levels. While most well infants can be monitored out of the hospital, infants who are anemic or have bilirubin levels approaching transfusion levels (approximately 20 mg/dL) should be admitted. 4243 and 44
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For many years, scientists have been playing out the ingredients that make breast milk the perfect food for babies. They've discovered to day over 200 close compounds to fight infection, help the immune system mature, aid in digestion, and support brain growth - nature made properties that science simply cannot copy. The important long term benefits of breast feeding include reduced risk of asthma, allergies, obesity, and some forms of childhood cancer. The more that scientists continue to learn, the better breast milk looks.