Anemia of Prematurity - Portal Neonatal

History:
CLINICAL Section 3 of 11
• Presentation and duration
o Typically, presentation is on the second or third day of life.
o Jaundice that is visible during the first 24 hours of life is highly likely to be
nonphysiologic jaundice and requires further evaluation.
o Similarly, infants presenting with jaundice after the third day of life may require
closer scrutiny.
o In infants with severe jaundice or jaundice that continues beyond the first week of
life, further family history should be explored.
• Family history
o Previous sibling with jaundice in the neonatal period
o Other family members with jaundice
o Anemia, splenectomy, or bile stones in family members
o Liver disease
• History of pregnancy and delivery
o Maternal illness suggestive of viral or other infection
o Maternal drug intake
o Delayed cord clamping
o Birth trauma with bruising
• Postnatal history
Physical:
o Loss of stool color
o Breastfeeding
o Symptoms of hypothyroidism
• Neonatal jaundice first becomes visible in the face and forehead. Identification is aided by
pressure on the skin, since blanching reveals the underlying color. Jaundice then gradually
becomes visible on the trunk and extremities. This cephalocaudal (or cephalopedal)
progression is well described, even in 19th-century medical texts. Jaundice disappears in the
opposite direction. This phenomenon is clinically useful because, independently of other
factors, visible jaundice in the feet may be an indication to check the serum bilirubin level.
• In most infants, yellow color is the only finding on physical examination. More intense
jaundice may be associated with drowsiness. Brainstem auditory evoked potentials
performed at this time may reveal prolongation of latencies, decreased amplitudes, or both.
• Overt neurologic findings, such as changes in muscle tone, seizures, or altered crying
characteristics, in a significantly jaundiced infant are danger signs and require immediate
attention to avoid kernicterus.
• Hepatosplenomegaly, petechiae, and microcephaly are associated with hemolytic anemia,
sepsis, and congenital infections and should precipitate diagnostic evaluation directed
towards these diagnoses. Neonatal jaundice may be exacerbated in these situations, but it
does not cause the findings.