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- Lisa Denike Bisgard, MD*
- *Doernbecher Children’s Hospital, Oregon Health and Science University, Portland, OR.
Presentation
A 10-week-old female infant who presents to her primary care physician for her 2-month health supervision visit has jaundice (Fig 1⇓ ). She is the product of a term pregnancy, delivered via elective repeat cesarean section. Her birthweight was 3,300 g (50th percentile). The mother denies having any infections or taking medications during her pregnancy. The infant has appeared yellow since birth. She was breastfed for the first 2 months, then switched to formula feedings when her mother believed she had an inadequate milk supply. The infant has had no feeding difficulties; she is taking 4-oz feedings five to six times per day.
Figure 1. A 10-week-old female infant who has jaundice.
For the past week, the infant has been colicky and fussy, but she has had no fever, vomiting, or diarrhea. Her appetite and urine output have been unchanged. There is no history of change in stool color; the stools always have been light yellow (Fig 2⇓ ). Nothing remarkable is noted on a review of systems.
Figure 2. Light yellow-colored stool.
The infant lifts her head well when placed on her abdomen, follows a moving object to midline, and responds to a friendly face with a social smile.
The patient lives with her mother and father and two siblings. All are healthy. She always has consumed treated city water, and she has not traveled recently.
There is a family history of ulcer disease, and the father had a hiatal hernia. There is no family history of blood transfusions, hepatitis, or emphysema.
Physical examination reveals an active, jaundiced female infant whose abdomen is distended. Her weight is 4.54 kg (10th percentile), length is 55 cm (5th percentile), and head circumference is 37.5 cm (5th percentile). Skin examination reveals an increased venous pattern over the abdomen (Fig 3 …
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