Pediatric emergency medicine trisk 2475 2475
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bilirubin levels and infants age (see Fig. 40.1 ). Infants with breast-milk jaundice
usually require increased breast-feedings, and close follow-up with pediatrician
until adequate milk supply is insured. Infants of diabetic mothers, infants with
congenital hypothyroidism, or with resorption from large cephalohematomas may
have higher levels of icterus than expected physiologically and may require serial
bilirubin level checks.
Pallor
CLINICAL PEARLS AND PITFALLS
Anemia in the neonate is recognized as pallor most commonly when
the hemoglobin falls below 10 g/dL.
Current Evidence. True pallor in the neonate can be due to significant anemia,
sepsis, shock, or severe chemical/electrolyte imbalance.
Clinical Recognition. Anemia in the neonate is recognized as pallor most
commonly when the hemoglobin falls below 10 g/dL.
Clinical Assessment. ED evaluation of pallor should include a careful history and
physical examination to distinguish between anemia, septic/cardiogenic shock,
electrolyte imbalance, and genetically determined fair skin coloring. Questions
should be asked regarding perinatal history, the baby’s feeding, level of alertness,
occurrence of vomiting or diarrhea, fever, and infant’s responsiveness. Careful
physical examination should include attention to vital signs, hydration status, and
lethargy, and search for cephalohematoma and hepatosplenomegaly. Consider
obtaining a CBC.
Dermatologic Findings
CLINICAL PEARLS AND PITFALLS
As few as one to two vesicles on an erythematous base, most
commonly on the scalp and face, may be the only presenting signs of
HSV infection, which should be considered even in the absence of
maternal signs or history of infection.
A tuft of coarse dark hair located in midline lumbosacral region may be
associated with spina bifida occulta.
