Pediatric Problem Solving -Case 8

Pediatric Problem Solving – Case 8
A 4week-old, full term, breast fed girl has worsening yellowish discolouration of the skin, that the parents first noticed 15 days ago. On her examination, she is well appearing with good suckling and reflex activity, and is noted to have a liver edge 4cm below her costal margin. Her total bilirubin is 12 and direct bilirubin is 9.
What is the most likely diagnosis
A. Biliary atresia

B. Cholecystitis

C. Sepsis

D. Breast milk jaundice Explanation of the case:

Explaination of the case.
Key points;
15 days = persistent jaundice
Appears good = not lethargic/septic
Hepatomegaly, direct bilirubin is more than 20% of total bilirubin , therefore cholestatic jaundice not breast milk.
 Choice (A): [the right choice] Points with: it Is not septic, nor breast milk + Direct bilirubin is more than 20% of total bilirubin + hepatomegaly
N.B: it is biliary atresia as it's the most appropriate choice in the choices given in this case, but it could be any other cause of cholestasis.
 Choice (B): not related to the case at all
 Choice (C): points against: she's appearing good with good activity

 Choice (D): if breast milk jaundice, it would have been indirect (unconjugated) bilirubinemia.