Case Study#1
Sammuel is a newborn boy at 32 hours of life. His birth weight was8 pounds. He was born via normal spontaneous vaginal birth at 40weeks of gestation to a 26-year-old G1. There were no maternalprenatal issues. Labor and delivery were complicated by a prolongedsecond stage of labor, which eventually progressed to spontaneousbirth. The Apgar scores were 6 and 8, and the infant was taken tothe nursery for an observation period; he received intravenous (IV)fluids but did well and so was discharged to the routine care inthe mother’s room at 12 hours of life. Sammy was noted to havefacial bruising and a cephalhematoma, which were attributed to theprolonged second stage of labor. All newborn blood work was normal.The group B streptococcal culture was negative. Maternal blood typeis A+. Exclusive breastfeeding was initiated at 12 hours of life.On physical examination, Sammy has some jaundice evident on thechest and torso.
- What risk factors does Sammy have for hyperbilirubinemia?
Case Study #1(continued)
The pediatrician orders a bilirubin level, and the total serumbilirubin level is 7 mg/dL. A repeat level is ordered in 8hours.
- Does this result indicate a dangerous level ofhyperbilirubinemia? Explain your answer.
- What are the risks to the newborn with elevated bilirubinlevels?
Case Study #1(continued)
Sammuel repeat total serum bilirubin was 5 mg/dL at 40 hours oflife, and the pediatrician has given discharge orders for thisevening when Sammy will be 48 hours old.
- What education regarding jaundice is appropriate for Sammy’sparents at this time?
