Case 2: Hyperbilirubinemia at Age 4 Days in an African American Infant

Abstract

A male African American infant is born at term to a gravida 4 now para 3 mother by uncomplicated spontaneous vaginal delivery after an unremarkable prenatal course. His Apgar scores are 9 and 9 at 1 and 5 minutes, respectively, and his birth weight is 3,515 g. Before 48-hour discharge, his total bilirubin level is 14.2 mg/dL (242.9 μmol/L). He is discharged home feeding well with formula. On the day of discharge, his weight is down 2.7% (3,420 g) from his birth weight. At his follow-up visit on the fourth day after birth, he is noted to have scleral icterus and jaundice down to his knees. His weight has increased from discharge to 3,435 g. A slightly hemolyzed heelstick total bilirubin measurement is 25.2 mg/dL (431.0 μmol/L) (direct component, 0.2 mg/dL [3.4 μmol/L]), and he is admitted for treatment of hyperbilirubinemia. Before admission, his parents report that he was taking 2 oz of formula every 2 hours and was producing yellow transitional stool with nearly every feeding. He has an older brother who had a history of jaundice that required phototherapy for 1 week, with no intravenous immunoglobulin (IVIG) or exchange transfusion required. Family history was negative for hemoglobinopathies, glucose-6-phosphate dehydrogenase, or anemia. His admission vital signs are as follows: temperature, 98.8°F (37.1°C); pulse, 128 beats per minute; respirations, 44 breaths per minute; oxygen saturation, 100% on room air; …