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September 23, 2004
Jaundice-o-meter

Having seen quite a few jaundiced babies the past month, I've been trying to get an idea for which of them need to have their bilirubin checked. Breastfeeding is common in the patient population here, so physiologic jaundice is pretty common. None of the reisdents or preceptors could really give me a good evidence-based bedside test to triage jaundice babies, so I asked my old pediatrician. He found me an ancient article that addresses this issue in a very old-timey doctor kind of way. Dermal icterus progresses from head to toe in a predictable way:

Where              Range of Total Bilirubin

Head                 4.3-7.8    

Chest                5.4-12.2

Pelvis                8.1-16.5

Extremeties     11.1-18.3

Hands and Feet    >15

Here's a look at phototherapy and how to treat jaundice - treatment depends on how old the kid is and there gestational age.. BTW - there's an element of breastmilk that inhibits the glucoronidation of indirect bilirubin, making breast-fed babies prone to jaundice ("physiologic jaundice"). Good luck on the exam.

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