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Pathologic neonatal jaundice — MCCQE Part 1 MCQ

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ModerateNeonatal JaundicePathologic neonatal jaundiceMCCQE Part 1

36-hour-old newborn presents with jaundice. Total serum bilirubin is above treatment threshold and the infant is sleepy. Which of the following is the most appropriate next step?

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Correct answer: E — Start phototherapy and evaluate for risk factors/haemolysis

Start phototherapy and evaluate for risk factors/haemolysis is best because early significant jaundice with lethargy requires treatment and assessment. Provide only reassurance without clear follow-up or safety-netting is suboptimal because children can deteriorate quickly and follow-up must be explicit; Use adult dosing or adult pathways without paediatric adjustment is suboptimal because children require age- and weight-appropriate care; Delay assessment until the next routine visit is suboptimal because developmental, infectious and neonatal red flags require timely assessment; Give antibiotics, steroids or investigations routinely despite no indication is suboptimal because over-treatment can cause harm when supportive or targeted care is indicated. Bilirubin thresholds depend on age in hours and risk factors.

Reference: Canadian Paediatric Society hyperbilirubinaemia guideline