Breast Milk Jaundice

Breast Milk Jaundice

Progressive increase in bilirubin from day 4, peaks at 10 to 15 days of life in breast-fed infant.
Treatment
Treat the underlying disorder.
Ensure adequate hydration, caloric intake, stooling.
Phototherapy is not indicated in those with liver disease or jaundice secondary to obstruction.
Prophylactic phototherapy. Indicated for infants showing a rapid rise in bilirubin (>1 mg/dl per hour) and as a temporizing measure when one is contemplating exchange transfusion.
Phototherapy. Serum bilirubin usually decreases by 2.5 to 3 mg/dl per day. Bilirubin level should be followed every 12 hours. Phototherapy should be discontinued when the bilirubin reaches levels of about 13 mg/dl. Bilirubin levels should be rechecked again 12 hours after discontinuation, to assess for recurrence.
Exchange transfusions. Needed when bilirubin level rises to 25 mg/dl or more in nonhemolytic jaundice, >20 mg/dl in hemolytic jaundice, or unresponsiveness to phototherapy.

**A 5-year-old white male is brought to your office for treatment 24 hours after being stung on the right hand by a bee. He has marked swelling of the right hand and forearm, redness, itching, and mild pain at the sting site. His mother says that the swelling began about 2 hours after the sting and is continuing to worsen. She is quite concerned and requests a referral to an allergist to have the child evaluated.

Which one of the following would be appropriate advice?

a. The child is unlikely to have anaphylaxis with subsequent stings, and he should be treated with antihistamines and antibiotics now
b. The child is unlikely to have anaphylaxis with subsequent stings, and he should be treated with antihistamines only now
c. The child's parents should carry an anaphylaxis emergency treatment kit with them at all times to treat future reactions
d. The child is at risk for anaphylaxis from subsequent insect stings, and immunotherapy may be appropriate
e. This type of reaction is not likely to occur with subsequent insect stings

B

This patient is experiencing a large local reaction to an insect sting. Symptoms usually worsen for 48 hours and may last up to 7 days. People who have had large local reactions to stings tend to have similar reactions after subsequent stings. The risk of anaphylaxis is less than 5% per episode. Immunotherapy will not prevent large local reactions, thus venom skin tests serve no purpose. An anaphylaxis emergency kit (Ana-Kit) is designed to treat anaphylactic reactions and would not be appropriate for this patient. Antihistamines and aspirin, with or without short-term steroid therapy, constitute appropriate treatment. Cellulitis rarely develops after an insect sting, and antibiotics are not indicated in most cases.

**A 5-year-old African-American male fell off his bicycle and hit the back of his head on a hard surface. There was no loss of consciousness. No other injury was noted. He was obviously agitated and restless, and his only complaint was a loss of vision. When you see him, his examination is unremarkable except for moderate swelling over the occipitoparietal area of the scalp. His skin is intact, and no gross neurologic deficit is noted except for the visual loss. A CT scan is negative. An EEG shows only slight slowing of activity.

Which one of the following statements is true regarding this patient?

a. The child's vision will probably return within 24 hours
b. The child should be hospitalized for 72 hours for further observation
c. It will be months before the child's vision returns
d. The loss of vision is probably caused by damage to the optic nerve

A

Transient cortical blindness following mild head trauma is usually associated with a benign outcome. The special features are mild head trauma, no loss of consciousness, onset of blindness occurring within hours of the trauma, duration of blindness less than 24 hours, absence of skull fracture or visible injury on CT scan, and no other neurologic deficits. The EEG shows initial slowing with normalization on follow-up.